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Kin 188  Pre Participation Physical Examinations
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Kin 188 Pre Participation Physical Examinations

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  • 1. KIN 188 – Prevention and Care of Athletic Injuries Pre-Participation Physical Examinations
  • 2. PPE
    • Goals of the PPE
    • Preparation for the PPE
    • Medical history
    • Components of the PPE
    • Clearance for participation
  • 3. Goals of the PPE
    • Determine general health and current immunization status
    • Establish rapport with participant
    • Detect medical conditions that can predispose one to injury/illness so treatment can be continued/initiated
    • Identify health risk behaviors that can be addressed with counseling
  • 4. Goals of the PPE
    • Establish baseline parameters for return to play decisions
    • Assess physical maturity
    • Evaluate physical fitness
    • Make recommendations regarding participation/exercise
    • Meet legal requirements to athletic participation
  • 5. Goals of the PPE
    • Specific focus of PPE varies amongst populations
      • Pre-pubescent
        • Undiagnosed congenital abnormalities
      • Pubescent
        • Maturation level, establishing healthy behaviors
      • Young adult
        • History of previous injury, sport-specific exam
      • Adult
        • Overuse conditions predominate
  • 6. Preparation for the PPE
    • No one best/right way to do PPE
    • Influenced by several factors
      • Level of competition
      • Availability of personnel and facilities
      • Number of PPE being conducted
      • Personal preference/history
  • 7. Preparation for the PPE
    • Format
    • Timing
    • Frequency
  • 8. PPE Format
    • Primary care physician model
      • Enhanced knowledge of medical history, immunization status and prior injuries that could limit participation
      • Generally a more thorough exam
      • Affords best privacy and better environment for counseling
      • Cost is expensive – insurance?
  • 9. PPE Format
    • Group/station model
      • Good for large number of PPE in given period of time
      • Allows better understanding of demands of activity
      • Individual personnel responsible for given element of PPE at “station”
      • Clearance verified by team MD at end of PPE
      • Typically free of charge
  • 10. PPE Timing
    • Ideally completed several weeks prior to initial practice
    • Allows ability to address any problems identified on PPE (labs, tests, records) without impeding participation status
    • Typically done within 1 week prior to first scheduled activity – high schools often over summer
  • 11. PPE Frequency
    • Entry-level PPE (complete) at outset of participation for school/organization
    • Recommended annual re-evaluation without complete PPE unless warranted
  • 12. Medical History
    • Generally accomplished ahead of time in yes/no format
      • Often a supplemental form for females
    • For station model, qualified evaluator must review history and red flag potential concerns for further scrutiny/evaluation
  • 13. Components of the PPE
    • Vital signs
    • General medical problems
    • Cardiovascular
    • Pulmonary
    • Musculoskeletal
    • Neurologic
    • Eyes
    • Dental
    • Gastrointestinal
    • Genitourinary
    • Dermatologic
    • Examination for heat disorders
    • Laboratory tests
  • 14. Vital Signs
    • Establishes individual’s baseline parameters
      • Height/weight
        • Comparison to normative data
      • Pulse/respiratory rate (60-100/12-16)
        • Observe quantity and quality
      • Blood pressure (120/80)
        • Cuff size very important
      • Body temperature (98.6/37.0)
        • Oral vs. tympanic vs. axillary (rectal)
  • 15. General Medical Problems
    • Questions asked regarding
      • Currently being treated for illness/injury
      • History of hospitalization or surgery
      • History of progressive disease (MS, MD, cancer)
      • Current use of OTC/Rx meds
      • Allergies to meds, food, environment
  • 16. Cardiovascular Examination
    • Done in quiet area to maximize validity
    • Auscultation of heart sounds
    • Questions asked regarding
      • Fainting (syncope), dizziness, SOB, chest pain with exertion
      • Heart palpitations, tachycardia, dysrhythmia, known murmur
      • Family member with sudden, early cardiac death
    • Positive responses to any necessitate referral to cardiologist for further evaluation
  • 17. Pulmonary Examination
    • Done in quiet area to maximize validity
    • Auscultation of breath sounds in all lung lobes – look for symmetrical movement of diaphragm
    • Questions asked regarding
      • Excessive coughing during/after activity
      • History of asthma, EIA, bronchitis, allergies
      • SOB, unusual breath sounds during/after activity
      • History of collapsed lung (pneumothorax)
  • 18. Musculoskeletal Examination
    • Basic exam consists of observation for symmetry, ROM, strength tests for major muscles and specific tests for previously injured areas
    • Questions asked regarding
      • Focus on history of injury, time frame, evaluation, treatment and rehabilitation
      • Use of protective devices
  • 19. Neurologic Examination
    • Evaluation consists of cranial nerve tests including pupil function, sensory/motor tests of UE/LE, deep tendon reflexes
    • Questions asked regarding
      • History of head injuries
      • Any previous loss of consciousness
      • Numbness/tingling, loss of motor function in body
      • History of seizures, burners/stingers
  • 20. Eye Examination
    • Visual acuity assessed via Snellen chart, both monocularly and binocularly (use corrective lenses)
      • Emmetropia (20/20 vision)
      • Myopia (nearsightedness)
      • Hypermetropia (farsightedness)
    • Questions asked regarding
      • Use of corrective lenses/type
      • Blurring or double vision
      • Color blindness, peripheral vision loss
      • History of eye trauma, retinal detachment
  • 21. Dental Examination
    • Typically done by dentist – not meant to perform preventative care but to establish pre-existing conditions for liability reasons in case of dental injury
    • Allows opportunity for dental molds to be made for crafting of custom mouthguard
  • 22. Gastrointestinal Examination
    • Evaluation of digestive system, eating habits and nutrition
      • Concerns for athletes where image is important to activity
    • Evaluation done supine with palpation for masses or organomegaly
    • Questions regarding
      • History of heartburn, indigestion, diarrhea or constipation
      • Prior history of organ injury (spleen, liver, kidney)
  • 23. Genitourinary Examination
    • For males, questions asked regarding
      • Hernias, testicular torsion, absent or undescended testicle
    • For females, questions asked regarding
      • Menstrual cycle, pregnancy
    • General questions asked regarding
      • History of bladder/urinary tract infections, STDs
      • Absence of one kidney
    • Can include urinalysis to look for proteins, blood, sugar and hemoglobin in urine
  • 24. Dermatologic Examination
    • Skin evaluated for rashes, lesions, infections that can be contagious to others
      • Herpes, fungal infections (tinea), impetigo, STDs, acne/treatment
    • Also look at existing blemishes (warts, moles, etc.)
      • Change in appearance (size, color, border, etc.) in recent past
  • 25. Examination for Heat Disorders
    • Especially important for activities taking place under conditions of high temperature, high humidity or a combination of the two
    • Questions asked regarding
      • History of heat illness (cramping, syncope, exhaustion, stroke)
      • Current meds (diuretics, antihistamines)
      • Use of caffeinated/alcoholic beverages
      • Nutritional and hydration habits
  • 26. Laboratory Tests
    • Not typical associated with PPE – usually due to cost of testing procedures
    • Often used when/if red flags appear during PPE
      • Urinalysis
      • Blood work
      • ECG
  • 27. Clearance for Participation
    • Conditions to be met to allow clearance by ME at end of PPE
      • Will condition increase risk of injury to individual or others?
      • Can participation be allowed if meds, rehab or protective bracing/padding is used? If so, can limited participation be allowed in interim?
      • If clearance is denied for particular activity, can other safe activities be identified and clearance be granted for them?
  • 28. Clearance for Participation
    • Individuals have right to participate in any activity regardless of pre-existing medical condition/s
    • Physician’s cannot exclude individual from participation – can only recommend against participation
    • Often use exculpatory waiver to identify and acknowledge assumption of risk
  • 29. Clearance for Participation
    • Examples of recommended disqualifying conditions (American Academy of Pediatrics)
      • Atlantoaxial instability
      • Aortic disorders
      • Convulsive disorders
      • Serious bleeding tendencies
      • Absence of paired organ for contact activities
      • Repeated concussions
      • Uncontrolled diabetes