Pre-participation Exam

Aka: Pre-participation Exam, Preparticipation Exam, Sports Physical Exam

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II. Background

  1. Most common abnormal physical findings
    1. Elevated Blood Pressure
    2. Decreased Visual Acuity
  2. Structured preparticipation physical is recommended
    1. Cardiovascular examination (e.g. pathologic Heart Murmurs) are a key focus of the exam

III. Exam: General

  1. Height
  2. Weight
  3. Body habitus
    1. Marfan Syndrome findings (tall and thin with long extremities and joint hyperflexibility)
    2. Low Body Mass Index (Female Athlete Triad)
  4. Vital Signs

IV. Exam: Eye

  1. Visual Acuity
    1. Blind in one eye OR
    2. Severe Myopia (Corrected worse than 20/50 in 1 eye)
  2. Protective eye wear (Glasses, Contact Lenses)
  3. Amblyopia
  4. Anisocoria
  5. Detached Retina
  6. Early Coronary Artery Disease changes
  7. Diabetic Retinopathy

V. Exam: Cardiovascular

  1. Examination points
    1. Blood Pressure (brachial)
    2. Pulse
      1. Rate and rhythm
      2. Distal pulse quality and symmetry (e.g. radial and femoral pulses)
    3. Cardiac auscultation for murmur (see below)
  2. Indications for Hypertension further evaluation
    1. Age <10 years old: Blood Pressure >130/75
    2. Age >10 years old: Blood Pressure >140/85
  3. Heart Murmurs
    1. Evaluate in 2 positions (e.g. Standing and squatting)
    2. Evaluate with Valsalva
    3. Indications for further evaluation
      1. Murmur grade 3 of 6 or louder
      2. Any Diastolic Murmur
      3. Murmur accentuated with Valsalva or on standing
        1. Suggests Hypertrophic Cardiomyopathy
    4. Further cardiac testing
      1. Electrocardiogram
      2. Stress EKG
      3. Echocardiogram
  4. Other findings requiring further evaluation
    1. Cyanosis

VI. Exam: Pulmonary

  1. Diaphragm excursion
  2. Breath Sounds
  3. Asthma
  4. Bronchitis

VII. Exam: Gastrointestinal

  1. Abdominal Masses
  2. Organomegaly
  3. Hepatosplenomegaly
  4. Kidney size

VIII. Exam: Dermatologic

  1. Acne Vulgaris
  2. Infectious rash (e.g. Herpes Simplex Virus)
  3. Atopic rash
  4. Suspicious nevi
  5. Surgical and Traumatic Scars

IX. Exam: Musculoskeletal

  1. Orthopedic screening: Brief Musculoskeletal Exam
  2. Back
    1. Scoliosis
    2. Kyphosis or Lordosis
  3. Knee and ankle (unstable)
  4. Shoulder (Recurrent dislocation)
  5. Assess elbow stability
  6. Painful Osgood Schlatter disease
  7. Marfan's Syndrome

X. Exam: Neurologic

  1. Gross coordination
  2. Gait Abnormality

XI. Exam: Genitourinary Male

  1. Testicles
    1. Single unpaired Testicle
    2. Undescended Testicle (Cryptorchidism)
    3. Testicular Masses
  2. Inguinal Hernia
  3. Tanner stage
    1. See Sexual Development in Boys
  4. Discuss Self-Testicle exam
    1. Testicular Cancer peak Incidence in age 18-35 years

XII. Exam: Genitourinary Female

  1. No longer done routinely with Sports Physical now
  2. Schedule separate gynecologic exam if indicated
  3. Ask about Amenorrhea (Female Athlete Triad)
  4. Tanner Staging or Menstrual dating
    1. See Sexual Development in Girls

XIII. Resources

  1. Preparticipation Exam
    1. https://www.aap.org/en-us/Documents/PPE-Physical-Examination-Form.pdf

XIV. References

  1. Kurowski (2000) Am Fam Physician 61(9): 2683-90 [PubMed]
  2. MacDonald (2021) Am Fam Physician 103(9): 539-46 [PubMed]
  3. Mirabelli (2015) Am Fam Physician 92(5): 371-6 [PubMed]

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