1. Valerie Robinson D.O.

2.   The goal of the preparticipation sports physical is to maximize safety of participants.  Identify life-threatening medical problems.  Identify and treat other medical problems that may interfere with participation. (e.g. asthma, HTN)  Identify previous injuries and try to prevent subsequent injuries  It does not substitute for a well child check. The Goals

3.   Most schools require annual physicals  Exam 4-6 weeks before sports season starts  May be done by the PCP  May be done in a station approach at locations set up by the school or local health department  Targeted medical hx  Targeted family hx  Target physical  Emphasis on musculoskeletal and cardiovascular  Labwork is not necessary The Exam

4.   Given that 30-78% of adolescents have a sports physical in lieu of a well child check, it may be appropriate to take the time to perform a complete check-up as well.  If performed in a private office, the physician may ask about drug use, sexual activity, violence, and mental health (e.g. depression or bullying) as part of a comprehensive check-up

5.   Medical history  Seizure, excess fatigue, shob  Injury history  Where, when, lingering effects?, LOC  Pain, paresthesia, decreased ROM  Cardiovascular history  HTN, murmur, dyslipidemia, myocarditis, endocarditis, rheumatic fever, syncope, near-syncope, angina, palpitations  Family history  Especially cardiac or sudden death, Marfan’s, syncope, SIDS  Surgical history  Medications  Immunization history  Menstrual history  History of weight changes The History

6.   Vitals, BMI  Low BMI, bradycardia, hypotension, hypothermia are symptoms of an eating disorder  HEENT – need acuity test  If corrected acuity <20/40, need protective eyewear  Lungs - auscultate  Abdomen - splenomegaly  Genitals – testes, discuss cup  Skin – anything contagious? (herpes, varicella, scabies, tinea corpora, molluscum contagiosum)  Lymphatic – lymphadenopathy, splenomegaly  Neuro – cranial nerves, focal defecits The Physical

7.   Pulse and BP, right arm while sitting  Auscultation done supine and standing  Innocent murmur – systolic, decreases when standing  Hypertrophic cardiomyopathy – may have no murmur. Systolic, increases when standing and with Valsalva, decreases with squatting  Aortic stenosis – ejection murmur, split S2, murmur may radiate to carotids  Mitral prolapse – midsystolic click, poss late systolic murmur  Locate PMI  Asymptomatic bradycardia (40-50 bpm)may be present in fit athletes - does not preclude activity  EKG is not recommended for screening purposes The Physical The Cardiac Exam

8.   If hx of injury, pay special attention to area involved  Look for asymmetry  Look for swelling, bruising, deformities  Watch for and ask about pain during exam  Test for weakness  Look for atrophy and watch for fasciculations The Physical Musculoskeletal

9.   Shoulder  Full abduction, flexion, external rotation  Resisted flexion and abduction, apprehension test  Elbow  Flexion, extension, supination, pronation  Hands  Flexion and extension of fingers, grip strength  Neck  Flexion, extension, rotation, sidebending The Physical Musculoskeletal 2

10.   Back  Look for scoliosis, spondylolysis  Flexion, extension, rotation  Hip  Flexion, extension, walk  “Duck walk” tests the hip and knee  Knee  Flexion, extension, walk, “duck walk”  Check for Osgood-Schlatter  Ankle  Hop several times on each foot The Physical Musculoskeletal 3

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15.   HTN  DM 1 or 2  Asthma  Exercise-Induced Bronchospasm  Dx by H&P. Spirometry or exercise challenge as indicated  Eating disorders  Treat psych. Cut exercise in half, esp. if 85% of IBW  Musculoskeletal injuries  Physical rehabilitation  Plan for return to activities. “Start low. Go slow.” Tx Before Participating

16.   Mitral prolapse – May participate UNLESS  Hx of syncope  Fam hx of sudden death d/t prolapse  Arrhythmias  Moderate or greater mitral regurg  Hx of emboli  Uncontrolled HTN  Fever Relative Contraindications

17.   Sudden death in the young athlete occurs with a prevalence between 1:100,000 and 1:300,000.  90% of deaths are in males, median age 17  Causes:  Hypertrophic cardiomyopathy  Wolff-Parkinson-White – delta waves, SVT  Long QT syndrome  Aortic stenosis – more common in Marfan’s  Commotio cordis – precordial blow disrupts heart rhythm  Coronary artery anomalies  Right ventricular hypertrophy  Myocarditis  Aortic rupture Sudden Death

18.   Albert C Hergenroeder, MD et al. “The preparticipation sports examination in children and adolescents.” UpToDate. Updated July 11, 2012. www.uptodate.comwww.uptodate.com  Stephen G. Rice, MD, PhD, MPH et al. “Medical Conditions Affecting Sports Participation.” Pediatrics Vol. 121 No. 4 April 1, 2008, pp. 841 -848. Retrieved from http://pediatrics.aappublications.org http://pediatrics.aappublications.org  Form: “Preparticipation Physical Evaluation Forms.” American Academy of Pediatrics. http://www.aap.org/en-us/professional- resources/practice-support/Pages/Preparticipation- Physical-Evaluation-Forms.aspx http://www.aap.org/en-us/professional- resources/practice-support/Pages/Preparticipation- Physical-Evaluation-Forms.aspx Refs