162 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
- The extent of testicular trauma and testicular blood flow
can be evaluated by ultrasound. Testicular rupture is a
urologic emergency requiring surgical management if
the testis is to be salvaged. Testicular contusions are
treated symptomatically. - Penile injuries are unusual in athletes. The penis
may be injured in straddle-type injuries or by direct
blow. Irritation of the pudendal nerve in bicycle
racers can cause priapism or ischemic neuropathy of
the penis. Symptoms usually resolve once the race
is over. - Penile frostbite occurs in runners who wear inade-
quate clothing in extremely cold conditions. - Female genitalia may be injured by direct trauma and
results in contusion, lacerations, or vulvar hematoma.
REFERENCES
Boileau M, Fuchs E, Barry JM, et al: Stress hematuria: Athletic
pseudonephritis in marathoners.Urology15:471, 1980.
Cianflocco AJ: Renal complications of exercise. Clin Sports Med
11:437, 1992.
Gerstenbluth RE, Spirnak JP, Elder JS: Sports participation and
high grade renal injuries in children. J Urol168(6):2575, 2002.
Jones GR, Newhouse I: Sports-related hematuria: A review. Clin
J Sport Med7:119, 1997.
McAleer IM, Kaplan GW, Lo Sasso BE: Renal and testis injuries
in team sports.J Urol168(4 Pt 2): 1805, 2002.
Nattiv A, Puffer JC, Green GA: Lifestyle and health risks of col-
legiate athletes: A multi-center study. Clin J Sport Med7:262,
1997.
Sagalowsky AI, Peters PC: Genitourinary Trauma, in Walsh PC,
Retik, AB, Vaughan ED, Jr, et al (eds.): Campbell’s Urology,
7th ed. Philadelphia, PA, Saunders, 1998, pp 3085– 3108.
28 OPHTHALMOLOGY
Ronica A Martinez, MD
Kayvan A Ellini, MDEPIDEMIOLOGY
- There are over 40,000 sports-related eye injuries in
the United States annually, with blunt ocular trauma
being the most common form of injury. - Nearly 90% of these are considered preventable (Erie,
1991; Jeffers, 1990; Cassen, 1997).- As a general rule, sports involving a stick, racquet, or
ball are considered high-risk for eye injuries. Other
sports to include in this category are basketball,
boxing, and wresting. - Hockey, baseball, and racquet sports account for the
majority of sports-related eye injuries (Napier et al,
1996).
- As a general rule, sports involving a stick, racquet, or
PREPARTICIPATION PHYSICAL
EXAMINATION- An eye examination is an important part of any sports
physical. - The ocular history should be sure to include the pres-
ence of severe myopia, prior eye injuries or surgeries,
and any history of retinal detachments, as these may
predispose the athlete to more threatening eye injuries
(Vinger, 1998). - Athletes with any of these predisposing risks should
be evaluated by an ophthalmologist prior to being
cleared for any high-risk sports. - Monocular athletes must wear protective eyewear at
all times. They should also understand that despite
using protective eyewear, participating in sports
places the good eye at risk for injury.
BASICS OF THE EYE EXAMINATIONHISTORY- The history should include a detailed description of
the mechanism of injury. Also obtain an estimate of
visual acuity immediately before and after the injury,
along with the timing of visual loss, if any. - Ask regarding pain, photophobia, diplopia, floaters,
flashing lights, tearing, headache, and nausea.
PHYSICAL EXAMINATION- The eye examination should be performed in a sys-
tematic fashion, using the uninvolved eye as a base-
line for comparison. Any asymmetry suggests a
problem that needs further investigation. It is also crit-
ical to perform a thorough examination, and not solely
focus on the obvious area of involvement. - Visual acuity:This is the first and most important
step of any eye examination. Document best corrected
visual acuity using a Snellen card or other text source.
If vision is too poor for text, check count fingers and
light perception.