Module 4: (a) Pre-participation Exams Flashcards
1
Q
Goals of the Pre-Participation Exam
A
- Maximize safe participation
- Identify medical problems w/ risk of life-treathening complications
- Identify conditions that require a treatment plan prior to participation
- Identify and rehab old injuries
- Identify and treat conditions that interfere w/ performance
- Remove unnecessary restrictions on participation
2
Q
Components of the PPE
A
- Medical History — MOST IMPORTANT PART OF THE EXAM TEST — Of the History, the Cardiovascular hx of pt and family is MOST IMPORTANT PART OF HISTORYTEST
- Physical exam
- Clearance Recommendations
3
Q
PPE: Medical Hx/ROS
-Heart Health Questions for Patient?
A
- Have you ever… During exercise? Yes/No
- Passed out or nearly passed out?
- Had discomfort, pain or tightness in your chest?
- Become lightheaded or dizzy?
- Does your heart race or skip beats?
- Has your doctor ever told you that you have heart problems?
- Has your doctor ever ordered a test for your heart?
4
Q
PPE: Medical Hx/ROS
-Heart Health Questions for the Family?
A
- Has a family member ever…?
-Died suddenly of heart problems or unknown cause < 50?
-Been diagnosed w/ any of the following
—Hypertrophic cardiomyopathy
—Marfan Syndrome
—Long or short QT syndrome
—Brugada syndrome
—Catecholeminergic polymorphic Vtach
-Had a pacemaker or impanted ICD
-Had unexplained fainting, near drowning or seizures
5
Q
Causes of Sudden Death in Athletes?
A
- Hypertrophic Cardiomyopathy = 36% TEST*
- Anomalous origin of coronary artery = 17%
- Myocarditis 6%
6
Q
Hypertrophic Cardiomyopathy HCM
A
- # 1 cause of sudden death among athletes
- Prevalence 1/500
- Non-dilated, hypertrophied left ventricle r/t to muscle thickening
- S/S —Dyspnea on exertion, chest pain, syncope w/ activity
7
Q
Athletic Heart syndrome
A
- Normal physiologic adaptations to training
- Heart becoems enlarged and the resulting pulse lowers
- Characterized by
- Bradycardia
- Cardiomegaly
- Cardiac hypertrophy
8
Q
PPE Bone and Joint Questions
A
- Atlantoaxial instability — Uncommon except with juvenile arthritis and down syndrome
- HIGH risk diagnosis and AUTOMATIC exclusion from contact sports
9
Q
PPE Medical Questions
A
- Respiratory
- Asthma — Not a disqualifier — may need to adjust meds - Impaired organ systems
- If patient was born with one organ (ie eye, kidney, testicle) have a plan to protect organ - MONO is a disqualifier for contact sports d/t risk of splenic rupture
- Neuro: Numbness or tingling or weakness in arms or legs after being hit or tackled
- This describes a “burner”or a “stinger”which is a nerve root compression injury
- Must be free of all sx’s to participate - Sickle Cell Trait or disease can increase risk of rhabdomylisis
- When a woman goes into ammenorrhea, the loss of estrogen surge can lead to bone density loss. Make sure she is menstrauting monthly
10
Q
PPE Physical Exam
A
- Vitals — Especially Obesity in BMI
- Murmurs of hypertrophic cardiomyopathy — Increased intensity with standing & Valsalva and better when lying down
- Benign murmurs decrease intensity with standing and increase when lying down
11
Q
Absolute COntraindications PPE
A
- Cardiac — myocarditis, cardiomyopathy, Coronary artery anomalies, ARVD
- Neuro — Concussion — day of injury w/ sx’s
- Seuzures — No swimming, weight lifting, archery/riflery, or sports involving heights
- One functional eye acuity <20/40 — No boxing, martial arts
- Infectious — diarrhea, conjunctivitis, fever, skin rashes
- Ortho — joint contracture, weakness, instability, cervical stenosis
12
Q
Mild Traumatic Brain Injury “MTBI”
-Info
A
- Any player who has significant impact to the head should be sidelined and not allowed to play the remainder of the day TEST
- 24-48 hrs of physical and cognitive rest post-concussion
- Should not retunr to sports until successful return to academics
- Slow progression in return to activity from dialy activity that do not provoke sx’s, to light exercise, ending w/ full retun to play
13
Q
Mild Traumatic Brain Injury “MTBI”
-Assessment
A
- HCP’s should use an age-appropriate, VALIDATED sx’s rating scale as a component of the diagnostic evaluation in children seen w/ acute mTBI
- Reassure parents that most children 70-80% will fully recover in 1-3 months after injury
- Recovery from mTBI is variable but coaching has positive effects on recovery
- Headaches persist longer in girls after mTBI
14
Q
PEDIATRIC ORTHOPEDIC CONDITIONS NEXT SLIDES
A
PEDIATRIC ORTHOPEDIC CONDITIONS NEXT SLIDES
15
Q
Pediatric Bone
A
- Pediatric bone is elastic
- Periosteum is thick/active relative to adult bone
- Ligaments are stronger than bone
- Presence of physes/growth plates
- Apohyses are weaker than bone (Connection of tendons to bone)
UNCOMMON for children to strain or strains
16
Q
Types of injuries specific to children
A
- Buckle fx - Compression injury (Most commonly radius - FOOSH - fall on onstretched hand
- Greenstick - Bone is bend w/ a fracture line
- Plastic deformation - Bowing fracture - bone is bent beyond ability to recoil
All of the above injuries are resultatn of forceful axial loading w/ resultant bony failure in compression and bending
- Physeal fx - “growth plate fx” salter-Harris classification
17
Q
Salter-Harris Fracture
A
- Fracture involving the growth plate and very serious - can delay growth if not treated appropriately
18
Q
Legg-Calve-Perthes Dx (HIP PAIN)
A
- Leg or hip pain **
- Avascular necrosis
- Unilateral and more likely male and ages 3-12
- Get Xray and MRI
19
Q
Slipped Capital Femoral Epiphysis SCFE
A
- Femoral epiphysis slips posteriorly resulting in limp and impaired internal rotaiton HIP PAIN
- Obesity and early adolecsence Risk factor
- May follow mild trauma
- Often will have a LIMP and hiup pain — May have pain to knee or thigh
- Urgent referral to Ortho or ED TEST - Non weight bearing — Surgery
20
Q
Pelvis Frog Leg Xray
A
- Order a Pelvis Frog-leg xray when a child has hip pain
21
Q
Osgood-Shlatter Disease (KNEE PAIN)
A
- Microtrauma to patellar tendon at its insertion point on the tibial tuberosity caused by tension at the insertion
- MOST common in adolescents after a growth spurt — MALES more than females
- Pain with extension against resistance, stress on quads or squatting
- Swelling/heat/ point tenderness over tibial tuberosity — Full ROM to knee
- This is diagnosed clinically, avoid activities that cause pain, Physical therapy
22
Q
Calcaneal Apophysitis (HEEL PAIN)
A
- Growth plate of acchilles tendon insertion
- Overuse causes inflammation of the insertion point causing heel pain
- 8-12 yrs old
- Pt history and Squeeze test
- Treat with
- Ice, limited activity, NSAID’s heel cup
23
Q
Developmental Dysplasia of the Hip DDH
A
- Spectrum of disorders seen in infancy r/t to development of the hip resulting in instability
- Screened at birth and 9 months or walking
- Ortolani and Barlow assessments
- If positive refer to ortho
- If unsure, order an US of the hip
24
Q
Genu Varum
A
- Bowing in the legs - Can be physiologic vs pathologic
- Signs of Pathologic
- Angle greater than 15 degrees
- Does not begin to decrease by age 2
- Asymmetry
- Progressive - Evaluation - Xray AP bilateral lower extermities — Get bilateral for comparrison
25
Genu Valgum (Knock Knees)
1. Physiologic vs pathologic “Knocking knees”
2. Physiologic peaks 24-36 months and lasts 7-8 yrs
3. Pathologic
- Metabolic bone dz (rickets)
- Skeletal dysplasia
- Tumor
- CP
26
In-Toeing
1. Usually non-pathologic and child will grow out of it
2. Assess parents concerns — POSITIVE REASSURANCE for parents
3. Assess for CP
4. MOST common cause of in-toeing is tibial torsion
27
Metatarsus Addactus
1. Commonly caused by intrauterin molding
2. Angulation of the midfoot w/ varrying degrees of severity
3. Assess degree of flexibility/rigidity
4. Mild cases usually resolve by 2
- Moderate to severe and flexible — teach parents to stretch the foot
- Non-flexible — Refer to ortho (serial casting)
28
In-Toeing & Tibial Torsion
1. Most common cause of in-toeing in age 1-4 years
2. Twisting of tibia along long axis — medially or laterally
3. Observe gain for in-toeing
4. 90% of cases resolved by 8 years w/out intervention
29
Talipes Equinovarus (Clubfoot)
1. Deformity of foot/feet in which medial deviation of forefoot is combined w/ excessive supination
- Sole of foot faces inward, Cavus (High midfoot arch), and ankel plantar flexion (Equinos
30
Growing Pains
1. Usually bilateral, intermittent in knees, shins (Lower extremities)
- Usual onset age 5
- Usualy associated with growthspurt**
Should respond to NSAIDs, HEAT, and reassurance
31
CC: Limp
1. Assess
- Gain
- wear pattern on the soles of shoes
- Soles of feet
- Joints
- Limb length discrepincy
32
Antalgic Gait
1. Short stance phase caused by pain in the weight bearing extremity
33
Trendelenburn gait
1. Downward pelvic tilt during swing phase caused by weakness or spasm in the contralateral gluteus medius muscle
34
Red Flags associated w/ LIMP
1. Fever
2. Elevated ESR, CRP
3. Constant/severe pain
4. Pain worse at night
35
Structural Scoliosis
1. Fam hx of scoliosis and age of menarch should be assessed - Diagnosis is curvature >/= 10 degrees on xray
2. Refer to ortho for management
- USPFTF recomments agains screening
- AAP recommends screening at age 10 and 12 for Females and 13-14 for males
36
Juveniles idiopathic arthritis JIA
1. Diagnosis criteria — Persistent arthritis for more than 6 WEEKS in a patinet <16 years
2. Suspect w/ ongoing joint pain
3. Order CBC, CRP, ESR and xray. Refer to Rheumatology
ANA and rheumatoid factor are NOT required to get another covid exam
