Sports Medicine: Just the Facts

CHAPTER 6 • CATASTROPHIC SPORTS INJURIES 25

appreciated only in the standing position or with a

Valsalva maneuver.

• Congenital coronary artery anomalies are a frequent
  cause of sudden cardiac death. These athletes may or
  may not have symptoms of syncope or chest pain with
  exercise making diagnosis difficult.


• Athletes with aortic stenosis and mitral valve prolapse
  have abnormal auscultatory findings that should lead
  to the suspected diagnosis.


• The preparticipation physical is critical for detecting
  cardiac conditions that may be life threatening.

HEAT ILLNESS

EPIDEMIOLOGY

• Heat illness is the third most common cause of death
  in athletes.


• Risk factors for heat illness include obesity, fever, recent
  respiratory or gastrointestinal(GI) viral illness, sickle
  cell trait, stimulants, supplements such as ephedrine,
  illicit drugs, alcohol, sleep deprivation, sunburn, and
  underconditioned athletes (Coyle, 2000).


• Heat illness usually occurs during unseasonable hot
  conditions at times of extreme exertion. A typical sce-
  nario is an obese football lineman wearing a football
  uniform and playing two a day practices during late
  summer tryouts in the Southeast United States.

CLINICALFEATURES

• Heat cramps is a misnomer and should be termed
  exercise cramps. Muscle cramping is triggered by
  fatigue and can occur at any temperature.


• Heat syncope is associated with an abrupt loss of
  consciousness in a heat-exposed athlete whose core
  temperature is normal or mildly elevated. The condi-
  tion often occurs toward the completion of exercise
  owing to reduced cardiac return and postural hypoten-
  sion. Heat syncope usually occurs during the first few
  days of heat exposure before the body has been
  allowed to acclimatize.
  •Heat exhaustion is defined as the inability to continue
  to exercise in the heat since the cardiovascular(CV)
  system fails to respond to workload. The condition
  occurs at core or rectal temperatures between 100.4
  and 104°F. Symptoms of heat exhaustion can include
  muscle cramping, mild confusion, headache, dizzi-
  ness, chills, nausea, and often collapse.


• Heatstroke is exercise-associated collapse with ther-
  moregulatory failure and central nervous system
  (CNS) dysfunction. Heatstroke and mental status
  changes begin at temperatures in excess of 104°F. The
  athlete may or may not be sweating. The condition

may result in a variety of life-threatening problems,

such as rhabdomyolysis, renal failure, disseminated

intravascular coagulopathy(DIC), liver failure, and

brain injury.

• The athlete with repeated heat illness requires a work-
  up for a muscle enzyme deficiency.

DIAGNOSIS ANDTREATMENT

•A correct diagnosis is based on the history, physical

examination, core body temperature, and differential

including hyponatremia and cardiac conditions.

•Treatment involves rapid cooling, moving to a cooler

environment, removing clothing, tepid water spray,

fans, and ice to the neck, groin, and axilla. Hydration

should include both oral intake and intravenous (IV)

fluids. Rehydration with sports drinks containing

electrolyes is preferred over water. Athletes with core

temperatures greater than 104°F should be considered

for cold water immersion. Emergency medical serv-

ices(EMS) should be contacted for athletes with heat

exhaustion and heat stroke.

PREVENTION

• The incidence of heat illness can be significantly
  reduced by frequent hydration, acclimatization, iden-
  tifying at-risk athletes, and monitoring daily weights,
  medication use, and status of recent illnesses.

DIRECT INJURIES

FOOTBALL

EPIDEMIOLOGY

•Football has the highest number of catastrophic head

and neck injuries per year for all high school and col-

lege sports (Mueller and Cantu, 2000).

MECHANISMS

• Spearing or tackling a player with the top of the head
  has been identified as a major cause of permanent cer-
  vical quadriplegia. When the neck is flexed 30°the
  cervical spine becomes straight and the forces are
  transmitted directly to the spinal structures. In 1976,
  spearing was banned and the rate of catastrophic cer-
  vical injuries dramatically dropped (Torg et al, 2002;
  Torg and Gennarelli, 1994).


• Cervical cord neurapraxia(CCN) is an acute, tran-
  sient neurologic episode associated with sensory
  changes with or without motor weakness or complete
  paralysis in the arms, legs, or both (Torg et al, 2002).
  Complete recovery usually occurs within 10 to 15 min
  but may take up to 2 days. The pincermechanism