Download Sports Physical PowerPoint - Fox Valley Health Professionals

Preparticipation Exam“Sports Physical”
Crystal Sturgis, PA-C, MSPAS
ThedaCare Orthopedic Care
Financial Disclosures
I do not have any financial relationships
or interests to disclose with relation to
any information provided in this talk
WIAA Requirements
A preparticipation physical fitness form attesting
to current physical fitness to participate in
sports as determined by a licensed physician,
Physician Assistant (PA) or Advanced Practice
Nurse Prescriber (APNP) no less than every
other school year with April 1 the earliest date
of examination (chiropractors are not accepted).
Athletic Disqualifications
There are two major considerations for restricting persons
from participation in athletics:
1. Is there a disease or condition which prevents the
individual from competing fairly with others?
2. Is there a disease or condition which might be
aggravated by athletic competition?
Both of these are relative and circumstances alter decisions.
It is the examining provider’s responsibility to determine
qualification or disqualification for athletic participation.
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Maturity
• The state of maturity varies greatly in adolescents of the same
age. Almost all boys/girls have reached the same stage of
maturity by the junior year in high school, but many freshmen
and some sophomores are not mature and should be
withheld from competing with boys/girls who are. At earlier
levels, seventh and eighth grades, it is important to identify
the boy/girl who is mature and prevent him from injuring his
classmates in athletic activities.
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Absence or Severe Disease of One of a Paired
Organ
• Most commonly involved organs are the kidneys, the eye and the
testicles.
• The American Academy of Pediatrics, the American Academy of Family
Practice and the American Medical Association all feel that if there is only
one of a paired organ left, then collision and contact sports should be
restricted. These athletes should be directed into the noncollision,
noncontact sports. If they are to be allowed to participate, every
safeguard must be taken to protect the uninjured paired organ that is left.
• Ultimately, may be a legal decision
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Hernia and Hydrocele
• Considered disqualifying until repaired.
• Hydrocele is usually associated with a hernia.
• The danger of hemorrhage into or around the hydrocele
as the result of a blow is great. This can result in
irreparable damage to the cord and the testicle.
• Repair should be done as soon as possible.
• Once repaired, the athlete can return to full competition.
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Head Injury
• No athlete shall return to play or practice on the same day of being
diagnosed with a concussion or rendered unconscious.
• Any athlete suspected of having a concussion must be evaluated by an
appropriate health-care professional that day.
• Any athlete with a concussion must be medically cleared by an
appropriate health-care professional prior to resuming participation in any
practice or competition. Return to play must follow a step-wise protocol
which includes provisions for delaying return to play based upon the
return of any signs or symptoms.
• Wisconsin state law requires concussion information sheets to be
distributed and acknowledged for coaches, parents, and athletes before
practice may be allowed.
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Orthopedic Conditions
• Epiphyseal conditions (Osgood-Schlatter, Legg-Perthes, etc.) determined
on case-by-case basis dependent on symptoms
• Back pain- Any student who has persistent back pain should be x-rayed
and closely evaluated for some congenital abnormality or early
rheumatoid spondylitis. Spondylolysis and Scheuermann’s disease
(osteochondrosis of the vertebra) are examples of causes of back pain that
should be considered as possible temporary disqualification for
contact/collision sports.
• Other orthopedic conditions should be evaluated on basis of symptoms
and severity
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Epilepsy and Diabetes
• When under control are not necessarily causes for restriction
from athletics
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Skin Diseases
• At least temporary disqualification when infections- bacterial,
viral or fungal- are present.
• Herpes infections are extremely contagious, especially in
wrestlers. The student with this infection should be restricted
until the infection is controlled.
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Asthma and Other Respiratory Conditions
• If controlled, not disqualifying. Appropriate consultations are
recommended.
Disqualifying conditions
from Wisconsin Interscholastic Athletic Association's Medical Policies and Procedures
• Disease of the Cardiovascular System
• Area of uncertainty and controversy
• Murmurs- not automatically disqualifying, but should have further
workup.
• Organic heart disease, especially rheumatic or congenital heart disease,
may be a reason for disqualification . Those who have mitral stenosis or
aortic stenosis may be seriously harmed by severe exertion.
• Cardiac arrhythmia not associated with organic heart disease is not
disqualifying
• Hypertension should be evaluated by repeated examinations. It is not
unusual to find high school athletes with elevated blood pressure on an
emotional basis. If it remains elevated, further evaluation is necessary to
rule out coarctation of aorta, unilateral kidney disease, or some other
congenital abnormality.
Sudden Cardiac Arrest/Death in Athletes
• Annual incidence is 1 in 80,000 high school athletes and 1 in
50,000 college athletes
• Most SCA/D events (50-61%) occur in males in football and
basketball
• 56-80% of SCA/D in athletes occurs during exercise, remainder
nonexertional
• Limited evidence that athletes have higher risk of SCA than
general population of similar age
Sudden Cardiac Arrest/Death in Athletes
• Prevalence of cardiac conditions associated with SCA/D in
athletes is approximately 0.3%
• Most common causes of SCA/D: Hypertrophic
cardiomyopathy, anomalous coronary arteries, idiopathic left
ventricular hypertrophy, arrthymogenic right ventricular
cardiomyopathy, dilated cardiomyopathy, myocarditis, long QT
syndrome, WPW, aortic dissection, and CAD
• Up to 44% of athletes with SCA/D have no structural cardiac
abnormalities on autopsy
• HCM prevalence in young athletic population is 1 in 800 to 1
in 2600, in general adult population is 1 in 500
History and PE for Cardiovascular Screening
• Personal history of CV symptoms (i.e. exertional syncope)
and/or family history of juvenile/young adult SCA/D or
inheritable cardiac conditions
• PE findings of HTN, pathologic murmur, physical stigmata of
Marfan’s and other connective tissue disorders
• Significant variance in providers’ diagnostic abilities
• Only detects about 20% of cardiac disorders with elevated risk
for SCA/D
EKG for Cardiovascular Screening
• Estimated 60% of cardiac disorders at risk for SCA/D have
detectable EKG abnormalities
• Risks: increased cost, false positives, false negative
• Risk-stratified screening may provide more benefit- males,
older age, African Americans, high risk sports, level of play
• Current recommendation from American Medical Society for
Sport Medicine: No conclusive evidence to make universal
recommendation for or against addition of EKG during preparticipation evaluation
Real Risks to Athletes
• SCA/D incidence remains very rare- 35 of the 7 million adolescents in
sports at risk
• 15-18,000 annual adolescent deaths from automobile injuries, many
involving alcohol/drugs
• 6,000 annual young adult homicide victims
• Suicide deaths over 5,000/year, with 50 to 200 attempts for every death
• 1 million pregnancies per year among American women age 19 or younger
• Up to 6 million cases annually of STIs in adolescents
• Teenagers account for nearly 50% of reported cases of child abuse
• Crucial for providers to address risk-taking behaviors and
other age-appropriate preventative topics
Sports Physical vs Well Child Exam
• Goldberg et al surveyed over 700 high school athletes
• For 78% of them, the sports physical was the only annual
health assessment.
• Best practice is to incorporate sports specific requirements
into regular health maintenance visit
• Multi-station screening sports physical not recommended
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Noisy
Rushed
Lack of privacy
Minimal parental communication
References
1.
Wisconsin Interscholastic Athletic Association Medical Procedures Guide
https://www.wiaawi.org/Portals/0/PDF/Publications/medicalproceduresguide.pdf
2.
Cavanaugh Jr. R, Miller M, Henneberger K. The Preparticipation Sports Physical: Are We Dropping the
Ball? Pediatrics 1995; 96;1151
3.
Drezner J et al, AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes:
Current Evidence, Knowledge Gaps, Recommendations and Future Directions. Clinical Journal of Sport
Medicine September 2016; Vol. 26, Issue 5, p347-361
Thank you
Crystal Sturgis, PA-C, MSPAS
ThedaCare Orthopedic Care