Pre-participation Special Circumstances

Aka: Pre-participation Special Circumstances, Sports Physical Special Circumstances

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II. Evaluation: Body fat analysis Indications

  1. Weight class sports
    1. Wrestling
    2. Rowing
    3. Martial arts
  2. Appearance sports
    1. Gymnastics
    2. Figure skate
    3. Diving
  3. Lean sports
    1. Distance Running

III. Labs

  1. No general screening lab tests indicated
  2. May obtain Hemoglobin For girls in endurance sports

IV. Evaluation: Exertional Syncope

  1. See Exertional Syncope
  2. Risk for sudden death
  3. Evaluation
    1. Electrocardiogram
    2. Echocardiogram
    3. Graded maximal Exercise Stress Test
    4. Event Monitor or Holter Monitor
    5. Tilt Table testing
    6. Electrophysiologic testing

V. Evaluation: Tall Athletes

  1. Tall Patient Definition (Marfan's Syndrome Risk)
    1. Male over 6 feet
    2. Female over 5 foot 10 inches
  2. Findings suggestive of Marfan's Syndrome (need 2)
    1. Family History Marfan's
    2. Cardiac murmur or mid-systolic click
    3. Kyphoscoliosis
    4. Anterior thoracic deformity
    5. Arm Span greater than height
    6. Upper to lower body ratio > 1 SD under mean
    7. Myopia
    8. Ectopic lens
  3. Further evaluation studies (for 2 criteria above)
    1. Echocardiogram
    2. Slit Lamp Exam

VI. Evaluation: Illness

  1. Blood borne pathogens (e.g. HIV)
  2. Infectious Mononucleosis (Splenomegaly)
    1. Risk of Splenic Rupture
  3. Febrile or Viral illness (Myocarditis risk)

VII. Evaluation: Closed Head Injury

  1. Repeated Concussion
  2. Strict criteria for return to Contact Sports

VIII. Evaluation: Altitude

  1. See High Altitude Sickness (includes prevention)
  2. History of Acute Mountain Sickness
  3. Acclimatization issues
  4. Prophylaxis (Acetazolamide)

IX. Evaluation: Female Athlete Triad

  1. See Female Athlete Triad
  2. Amenorrhea
    1. Primary Amenorrhea (No Menses by age 16 years)
    2. Secondary Amenorrhea (Missing 3 consecutive cycles)
  3. Bone Mineral Density
    1. Cortical Bone affected by inadequate Estrogen
    2. Stress Fractures
    3. Bone density significantly impacted by Amenorrhea
      1. Amenorrheic age 25 athlete with age 50 bone density
    4. Consider Bone Mineral Density testing with DEXA Scan
  4. Nutrition
    1. Lowest common denominator in Amenorrhea, Overtraining
    2. Adolescent female athletes often eat too few calories
    3. Consider screening with nutritional questionnaire

X. Evaluation: Disability (includes Special Olympics)

  1. Common disabilities
    1. Amputation
    2. Blindness
    3. Cerebral Palsy
    4. Cognitive Impairment
    5. Deafness
    6. Down Syndrome
    7. Multiple Sclerosis
    8. Muscular Dystrophy
    9. Paralysis
  2. Precautions
    1. Many disabilities are associated with Visual Impairment, cardiovascular defects (e.g. Down Syndrome)
  3. Down's Syndrome needs Cervical Spine XRay
    1. Rule-out Atlantoaxial Instability
    2. Risk of C1 and C2 dislocation

XI. 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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