Pre-Participation Exam Jamie B. Varney, M.D. - PowerPoint Presentation

1. Pre-Participation ExamJamie B. Varney, M.D.CAQ Sports MedicinePikeville Medical Center Orthopedics and Sports Medicine

2. Update for ProvidersIntroCardiac Exam and AbnormalitiesMedical Conditions in AthletesConcussion and Neurologic Injury

3. Why is it necessary?No proven benefitMost sports med experts agree that it is beneficialOver 30 million children and adolescents participate in organized sports1Occasionally is the only contact with health care providerShould not take the place of standard preventative visit, but can point out certain deficiencies

4. Goals of Encounter1Identify medical problems with risks of life threatening complications during participationIdentify conditions that require a treatment plan before or during participationIdentify and rehabilitate old injuriesIdentify and treat conditions that interfere with performanceRemove unnecessary restrictions on participationAdvise athletes regarding appropriate sports in which to participate or not

5. Regulations49/50 States and D.C. require some form of exam(not Rhode Island)KY requires annual examsSome states allow parental exemption

6. Setting of ExamShould occur 4-6 weeks prior to competition if possible to allow time for appropriate work up or follow up on conditionsMay occur in office with single provider or assembly line or station formatMany different types of providersKY: MD/DO, PA, ARNP, DC (if in scope of practice)No consensus on frequency

7. SettingOfficeProsPrivacyContinuityKnowledge of prior historyConsTime consumingCost inefficientPossibility of less experience with examStationProsTime efficientCost efficientSports orientedConsNo continuityRequires volunteers

8. Sample Station Exam Set UpRecommendedOptionalHistory formVitals (resting pulse,BP)Height and Weight (BMI)VisionCardiorespiratoryGI/GUNeurologicMusculoskeltalSpineUpper ExtremityLower ExtremityDentalNutritionStrengthFlexibilityEndurance/strength/speedBody compositionProvider reviews all data and determines clearance and issues that need followed up

9. Key History ElementsPersonal and family medical historyCardiovascular (see guidelines)Respiratory (Asthma/EIB)Chronic Medical ConditionsHypertensionDiabetesSeizure disorderCongenital or acquired abnormalitySingle Kidney, Testicle, EyeMedicationsPrescription and OTCSupplements or performance enhancersAllergiesInsect envenomation? Epi-pen

10. Key History ElementsInjury HistoryMusculoskeletalSprain, fracture, dislocation, stress fracture, tendonitisConcussion/StingersHeat IllnessUse of protective devicesSurgical HistoryMenstrual HistoryWeight HistoryAttempt at loss/gainSupplementsImmunization HistoryPrevious exclusion from sports

11. Laboratory TestingNot recommended routinely1

12. KY Pre-Participation FormWV Pre-Participation Form

13. Stigmata of Marfan syndromeArm span greater than heightArachnodactylyPectus deformityHypermobilityEctopia Lentis

14. Arachnodactyly2

15. Pectus Carinatum3Pectus Excavatum4

16. Ectopia Lentis5

17. Range of Motion and StrengthNeckFlex, extend, side-bending, and rotationShoulderFlex, abduct, internal/external rotationElbowFlex, extend, pronate, supinateHands/WristFlex, extend, spread fingers, make fist BackFlex, extend, side-bending, and rotationHipsFlex, extend, internal/external rotationKneeSquatting / Duck walkAnkleToe raises, hopping

18. 2 Minute Orthopedic Exam6

19. Special ConsiderationSport specific focused exam Pitchers: Shoulder / elbowKnee exam in high risk sportsBack Pain/ScoliosisRarely contraindication unless curvature > 40 °7If has back pain especially in extension consider spondy

20. Respiratory ExamNote any wheezing or history suggestive of EIB/Asthma

21. Abdominal ExamAcute organomegaly is a disqualifying condition for contact sports8History of solitary KidneyNot definitely limiting8Should discuss risks/benefits with patient/parentRare occurrence of injury resulting in loss or surgery7Consider protective gear and nature of sport

22. GenitourinaryDepends on setting, some recommend only if history suggests an issueMales onlyDetection of herniaDetection of single or undescended testicleNot limiting but should wear protection and weigh risks/benefits7/8Undescended testis should be referred for urologic evaluation

23. Eye ExamFunctionally one eyed athlete <20/40 in worst eye Exclude from Boxing/MMA8Can compete in most other sports but may need further evaluation8Remember protective eyewear especially in high risk sports and for those with only one good eyeNote anisocoria if present in case of head injury

24. Skin ExamParticular attention to infectious lesionsMay restrict participation in events that involve close physical contact (i.e. wrestling)or shared equipment (gymnastic mats)

25. Medical Conditions and Participation8

26. ReferencesAmerican Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine. Preparticipation Physical Evaluation, 4th Ed., Bernhardt D, Roberts W (Eds), American Academy of Pediatrics, 2010 Arachnodactyly Image http://www.nature.com/ejhg/journal/v15/n7/fig_tab/5201851f3.html#figure-titlePectus Carinatum Image http://bms.brown.edu/pedisurg/Brown/IBImages/Thorax/PectusCarin.htmlPectus Excavatum Image http://www.patient.co.uk/showdoc/40001822/Ectopia Lentis Image http://www.patient.co.uk/showdoc/40001822/Mellion, M. et al. Team Physcian’s Handbook 3rd edition.Hanley & Belfus Inc. 2002.Hergenroeder, A. UpToDate. The Preparticipation Sports Examination in Children and Adolescents. (6-17-2014). Rice SG, American Academy of Pediatrics Council on Sports Medicine and Fitness. Medical conditions affecting sports participation. Pediatrics 2008; 121:841.

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