Preface

ix

Chapter 1

Introduction

1

Routine Screening Tests

2

Chapter 2

Goals and Objectives

7

Primary Objectives

7

Secondary Objectives

8

Chapter 3

Timing, Setting, and Structure

11

Qualifications of the Examiners

11

Timing of the Evaluation

12

Frequency of the Evaluation

13

Methods and Setting of Evaluation

14

Interim Annual Evaluations

17

Chapter 4

Administrative, Ethical, and Legal Concerns

19

Administrative

19

Ethical

22

Legal

23

Chapter 5

General Considerations of the History, Physical Examination, and Clearance

27

History

27

Physical Examination

28

Determining Clearance

29

Clearance Considerations

29

Chapter 6

Systems-Based Examination

39

A

Cardiovascular Problems

39

History Form Questions

39

Key Points

39

Incidence of Sudden Cardiac Death in Young Athletes

40

Etiology of Sudden Cardiac Death in Young Athletes

41

Personal and Family History

47

Physical Examination

49

Investigation of Athletes with Cardiovascular Symptoms

51

Limitations of the Preparticipation Cardiovascular Evaluation

51

Noninvasive Cardiovascular Screening in Athletes

52

Clearance Recommendations for Athletes with Identified Cardiovascular Disease

53

B

Central Nervous System

58

Concussions

58

Seizures

62

Headaches

63

Stingers or Burners

64

Cervical Cord Neurapraxia

66

C

General Medical

70

Medical History

70

Obesity

71

Diabetes Mellitus

72

Blood-Borne Pathogens: HIV and Hepatitis

73

Medications and Supplements

74

Allergies and Anaphylaxis

74

Surgical History

75

Paired Organs/Organs

76

Infectious Mononucleosis

76

Heat Illness

77

Sickle Cell Trait or Disease

79

Eye Disorders and Vision

80

Immunizations

84

Questions that may be Prompts during the Follow-Up Interview

84

D

Pulmonary System

93

Asthma and Exercise Asthma

93

E

Gastrointestinal/Genitourinary

97

History Form Questions

97

Secondary Questions

97

Key Points

97

Physical Examination

97

Clearance for Participation

98

F

Dermatologic Conditions

102

History Form Questions

102

Secondary Questions

102

Key Points

102

Physical Examination

103

Clearance for Participation

103

G

Musculoskeletal Concerns

107

History Form Questions

107

Key Points

107

Physical Examination

108

Clearance for Participation

117

H

The Female Athlete

120

Medical History

120

Physical Examination

125

Determining Clearance

127

Chapter 7

The Athlete with Special Needs

131

Benefits of Sports

131

Preparticipation Physical Evaluation (PPE) for Special Needs

132

Competitions for the Physically or Cognitively Impaired

132

Methods of Evaluation

133

The PPE Medical History

133

The PPE Physical Examination

135

Functional Assessment

138

Diagnostic Imaging

138

Determining Clearance

138

Chapter 8

Research

141

History

141

Physical Examination

141

Screening Studies

142

Standardization of the PPE

143

Electronic PPE

144

Conclusion

144

Chapter 9

Conclusion

147

Forms

151

History Form

153

The Athlete with Special Needs: Supplemental History Form

154

Physical Examination Form

155

Clearance Form

156

APPENDICES

157

Appendix A

Example of a College PPE Consent Form

159

Appendix B

Example of a Teen Screen Used in Minnesota

160

Appendix C

Sport Concussion Assessment Tool 2

161

Appendix D

Coding for the Preparticipation Physical Evaluation

166

Appendix E

Quick Reference to Useful Codes for the Preparticipation Physical Evaluation

167