Young Athlete Injuries Krishna Khanal, MBBS MD CAQSM FAAFP VA Hudson Valley Health Care System, Montrose, NY 01/27/2017

Conflict of Interest None

Objectives Discuss importance of History and Physical Exam. Explain Imaging are extensions of Physical Exam only. Manage sports injuries in effective and timely manner.

Time and Sports Injuries Head injury: second impact syndrome Neck Injury: burners and stingers Nasal septal hematoma Compartment syndrome Current Sports Med Rep. 2008;7(1):12-15

History and questionnaire Most useful tool for identification. Identifies 75% of problems. Clin J Sports Med. 2006; 16(5):437-438

Red Flags Exertional dizziness Heart Murmurs Murmurs worse with Valsalva H/O Transient quadriparesis Illegal supplement use Heat Related Illness Hypertension Female athlete triads JAMA. 2006;296(13):1593-1601

MRI in the setting of Normal X-ray When the suspicion of injury is high and plain films are normal specially in weight bearing bone. Radiology. 2008:247(3):797-807

CT scan Clinical history will affect both image acquisition and interpretation. Open communication between clinician and radiologist is essential for optimum patient care. Plain radiographs are usually the first imaging study that should be performed. Preferred for complex bone trauma like pelvic injuries. British Journal of Radiology 2005;78(929):457-68.

Athletic Heart Syndrome Role of EKG in the preparticipation screening is controversial. Most EKG changes in well conditioned athletes are benign reflections of structural and functional changes. Advancements in physician education and improvements to our health systems infrastructures are needed as EKG screening becomes more available. British Journal of Sports Medicine 2009; 43(9): 669-76.

Syncope and Exercise Associated Collapse Careful history can differentiate benign from life threatening etiologies. American Family Physician. 1999;60(7):2001-2008.

Hypertension Inquire history about substances like NSAIDs, stimulants, anabolic steroids etc. Med Sci Sports Exerc. 2004;35(%):S102

Eyelid Laceration Involving lacrimal duct drainage system, full thickness lacerations, exposure to orbital fat and lacerations involving lid margin need urgent referral to ophthalmologist. Modern Sports Eye Injuries. Br J Ophthalmology, 2003:87(11):1336-9.

Sickle Cell Trait Vigorous exertion at altitudes of 5000 ft or more may result sickling and its sequelae. Phys.Sportsmed. 1993;21(7):51-64.

COPD in adults Exercise training and pulmonary rehab should be considered for all patients who experience exercise intolerance despite optimal medical therapy. Clin Chest Med. 2000;21(4):763-81

Environmental Injuries Ethanol and psychiatric problems underlie up to 70% of most cases of frost bite. Med Sci Sports Exerc. 2007;39(11):2058-68

Bracing for back pain Useful in acute setting or for fracture. Ann Phys Rehab Med. 2010; 53(*):511-9.

Young athletes: shoulder pain evaluation MRI an excellent tool for determining rotator cuff pathology but often overused or obtained too soon. MRA more informative than MRI. Eur Radiology 2006:16(12):2622-36.

Contralateral comparison Distinguishes from normal anatomical variant. J Sports Medicine 1973;1(4):5-17.

Pediatric injuries Obtain contralateral side comparison view to differentiate between normal ossification centers and fractures. Posterior fat pad sign. All the fracture may not be visible. May need repeat x-ray, additional imaging or referral. J Bone Joint Surg Am. 1999;81(10):1429-33

Ottawa Ankle Rules Every sprained ankle do not require screening radiographs. Know the exceptions. JAMA 1993;269(9):1127-32.

X-rays Orders and Standard Views Shoulder x-rays, weight bearing views etc. Clin Orthop Relat Res. 1988;(234):28-30.

Complementary and alternative medicine Common in use. Always ask. Know the common side effects. Most ergogenic aids lack scientific proof. JAMA. 1998;280(18):1616-8.

Post-operative athletes: return to play Demonstrate resolution of pain, swelling. Attainment of the normal ROM and strength. Psychologically ready. Clin Sport Med. 2010;29(2):203-211

Common Syndromes Marfan’s Syndrome Fragile X Syndrome Ehler Danlos Syndrome American J Medical Genetics 1996;62(4):417-26.

Summary Thorough history and physical exam: crucial part of assessment. Sound judgement before ordering the test. Time important factor in the management of sports injuries.

Questions

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