Andy Ashbaugh DO MPH UNM primary care Sports Fellow Disclosures I have a lot of student loans and no commercial company is giving me money I have adapted slides from Dr Daniel Day DO from ID: 612549
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Pre-participation Sports Exam
Andy Ashbaugh DO MPHUNM primary care Sports FellowSlide2
Disclosures
I have a lot of student loans, and no commercial company is giving me money I have adapted slides from Dr. Daniel Day D.O. from Virginia TechSlide3
Objectives
Understand why Pre-participation exams are doneHow to find the APS pre-participation formUnderstand the importance of the historyLearn how to do the approved AHA/ACC cardiovascular examLearn the 2 minute MSK exam (plus some added tests)Slide4
Why do we Do pre-participation exams?
Detect conditions that may predispose athletes to injury or worse.Untreated illness or injuriesCongenital or Developmental issuesCardiac issuesDetect conditions that may limit safe participation
Medications/SupplementsIllicit drug useEating habits/Menstrual disordersHearing/Vision ProblemsSlide5
Why do we Do pre-participation exams?Slide6
Why do we Do pre-participation exams?Secondary Objectives
General Health Screen: For a lot of athletes, this is the only exam they get (some studies showing up to 80%)Offers a good opportunity for a general health exam or well child checkSlide7
Evidence for pre-participation exams
No Evidence that PPE’s reduce death rates.Slide8
Practical Issues
Patient comes in for a sports physical and does not have the formSlide9
www.aps.eduSlide10Slide11Slide12Slide13
History
A good history can identify over 75% of problemsSlide14Slide15
It is prudent to ask if the athlete filled out the form or their parents. There is only a 39% correlation between the athletes answers and the parents.Slide16Slide17Slide18Slide19
What are the Cardiac causes of Sudden death in young athletes.
HOCMArrhythmogenic Right Ventricular CardiomyopathyPre-excitation/Conduction diseases (WPW)Ion channel diseases (brugada)
Annual Incidence is about 1-2 per 200,000 athletesSlide20Slide21Slide22
Concussions
About 2 million TBI’s per year, of which 21% occur in high school athletesAccount for about 13% of all high school athletic injuriesMost commonly occur in football and women’s soccerSlide23
Concussion Hx
Important to find out how many they have had (there is no # that will disqualify them)Find out how long they were out and what there return to play protocol was and how long it tookImportant to know that there is no equipment that will prevent concussions.Slide24Slide25
Female athletic Triad
Disordered Eating/Energy DeficiencyMenstrual IrregularitiesBone Loss/Osteoporosis (stress Fx’s)Slide26
Questions Thus Far?Slide27
Physical ExamSlide28
Physical Exam: vitalsSlide29
Physical Exam: Blood pressureSlide30
Physical Exam: Visual Acuity
Anything under 20/50 is acceptableIf 20/50 or greater in either eye or both, need to make sure their vision is correctableIf vision not correctable, athlete needs to wear protective eyewearSlide31
Physical Exam: Appearance
Looking for Marfanoid appearanceSlide32
Physical Exam: HEENT
Consists of visual acuity, PERRL, oropharynx, hearing, throat, lymph nodes Slide33
Physical Exam: Respiratory
Normal examination, can adjust based on athletes historySlide34
Physical Exam: CardiacSlide35
Physical Exam: Cardiac
Murmurs:Laying supine: Increases preload; innocent still/flow murmur will increaseStanding/Valsalva: decreases preload; pathologic murmur (HOCM) will increasePulses:Check Radial and Femoral at same time
If femoral pulse weaker than radial, concern for coarctationSlide36
Physical Exam: Cardiac
What about getting an ECGThey are greater than 90% for specificity and sensitivity for pathologic heart findings if read by physicians trained in reading ecg’s for athletesLarge study ongoing in SeattleThese diseases have a very low incidence, have to weigh cost of test vs burden of disease
Has to be a system in place to handle abnormal tests. How many of your pediatric patients can be seen quickly by a pediatric cardiologist?Slide37
Physical Exam: GI
Evaluating for Hepatomegaly or SplenomegalySlide38
Physical Exam: Skin
Looking for anything contagious (Fungal, Molluscum)Slide39
Physical exam: Neuromuscular
2 minute MSK examI incorporate Neuro exam with MSK examSlide40
2 minute MSK exam: 97% spec, 51% SensSlide41Slide42Slide43Slide44Slide45Slide46
Physical exam: Neuro
DTR’s, Sensation, BalanceSlide47
Physical Exam
My neuromuscular examI need a volunteerSlide48
Questions?