DIAGNOSTIC TESTS
LABTESTS
- The most commonly used lab tests are the complete
blood count(CBC) and urinalysis. Consensus is that
they should not be done routinely during the prepar-
ticipation examination. - Consider routine hematocrit in female athletes.
- Cholesterol testing if indicated by history.
- Consider testing for sickle cell trait in black athletes.
CARDIACTESTING
- Routine electrocardiogram(EKG) and/or echocardio-
gramare not cost effective as screening tests.
•Exercise stress testing may be indicated in the adult
athlete with cardiac risk factors, prior to starting an
exercise program.
CLEARANCE
- After a problem is found, the following factors should
be considered in deciding whether to clear an athlete
to participate:
a. Does the problem place the athlete at increased
risk of injury?
b. Is any other participant at risk of injury because of
the problem?
c. Can the athlete safely participate with treatment
(medication, rehabilitation, bracing, or padding)?
d. Can limited participation be allowed while treat-
ment is being initiated?
e. If clearance is denied only for certain activities, in
what activities can the athlete safely participate? - The American Academy of Pediatrics Recom-
mendations for Participation in Competitive Sports is
a useful guide to help decide about clearance (see
Tables 12-4(a), 12-4(b), and 12-5).- The “26th Bethesda Conference: Recommendations
for Determining Eligibility for Competition in Athletes
With Cardiovascular Abnormalities” covers guidelines
for clearance in athletes who have congenital heart dis-
ease and other cardiovascular abnormalities. - A clearance form (see Fig. 12-2) is a useful tool to
clearly express recommendations regarding clearance.
SCREENING TO PREVENT EXERCISE RELATED
SUDDEN DEATH- Preparticipation screening is the primary preventive
tool. The incidence of exercise related sudden death
rate is rare—around 0.2–0.5 per 100,000 adolescents
per year. - The cause is usually cardiac: under 30 years, usually
structural heart problem; over 30 years, usually coro-
nary artery disease. Causes include the following:
HYPERTROPHICCARDIOMYOPATHY- Symptoms: palpitations, syncope, chest pain, and dys-
pnea on exertion. Most are asymptomatic until the
time of death. - Examination: may have high frequency systolic ejec-
tion murmur at the left lower sternal border, increased
with Valsalva, decreased with squatting. - Diagnosis: echocardiogram (ventricular septum >15-mm
thick). The presence of the “athletic heart syndrome” may
complicate screening.
CONGENITALCORONARYARTERYANOMALIES- Types:
a. Origin of left coronary artery from right of sinus of
Valsalva
b. Single coronary artery
70 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE
TABLE 12-4(a) The Classification of Sports by Strenuousness
HIGH TO MODERATE HIGH TO MODERATE HIGH TO MODERATE LOW DYNAMIC
DYNAMIC AND STATIC DYNAMIC AND LOW STATIC AND LOW LOW STATIC AND
DEMANDS STATIC DEMANDS DYNAMIC DEMANDS DEMANDS
Boxing Badminton Archery Bowling
Crew/rowing Baseball Auto racing Cricket
Cross-country skiing Basketball Diving Curling
Downhill skiing Field hockey Equestrian Golf
Fencing Orienteering Field events (jumping) Riflery
Football Ping-pong Field events (throwing) —
Ice hockey Racquetball Gymnastics —
Ice hockey Soccer Karate or judo —
Rugby Squash Motorcycling —
Running (sprint) Swimming Rodeoing —
Speed skating Tennis Sailing —
Water polo Volleyball Ski jumping —
Wrestling — Water skiing —
——Weight lifting —