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Young Athlete Injuries

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Presentation on theme: "Young Athlete Injuries"— Presentation transcript:

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

2 Conflict of Interest None

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

4 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

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

6 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):

7 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):

8 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):

9 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):

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

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

12 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):

13 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.

14 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

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

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

17 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):

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

19 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):

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

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

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

23 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):

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

25 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.

26 Questions

27 Thank you!


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