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Pre-participation Special Circumstances

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Pre-participation Special Circumstances, Sports Physical Special Circumstances

  • See Also
  1. Preparticipation Physical Evaluation
  2. Pre-participation History
  3. Pre-participation Exam
  4. Station Divided Sports Physical
  5. Sports Participation Disqualifiers
  6. Sports Contact Levels (Contact Sport or Collision Sport)
  7. Sports Intensity Levels (Dynamic Sports, Static Sports)
  8. Athletic Heart Syndrome
  9. Arrhythmias in Athletes
  10. Sudden Death in Athletes
  • 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
  • Labs
  1. No general screening lab tests indicated
  2. May obtain Hemoglobin For girls in endurance sports
  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
  • 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
  • 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)
  1. Repeated Concussion
  2. Strict criteria for return to Contact Sports
  • Evaluation
  • Altitude
  1. See High Altitude Sickness (includes prevention)
  2. History of Acute Mountain Sickness
  3. Acclimatization issues
  4. Prophylaxis (Acetazolamide)
  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
  • 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
  • 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]