Preparticipation Sports Exams for Young Athletes: Components of the Exam

Medical History
Parents should help fill out the medical history form, because athletes often provide different information than parents do: eg, the athletes tend to omit important information, and the parents are more knowledgeable about family history. The form should ask about recent or chronic problems, hospitalizations, surgical procedures, prescription and nonprescription medications, and allergies or anaphylactic reactions to medications, insects, and exercise. It should also inquire about all of the different systems of the body, starting with the heart.

Heart
The form should follow the AHA Guidelines(3) in asking about:
• Chest pain or chest discomfort
• Syncope or near syncope
• Excessive, unexpected, and unexplained shortness of breath or fatigue associated with exercise
• Past detection of a heart murmur or high blood pressure
• A family history of premature death or significant disability from cardiovascular disease in close relatives younger than age 50
• Hypertrophic cardiomyopathy, dilated cardiomyopathy, Marfan syndrome, long QT syndrome, and arrhythmia.

Skin
Warts, fungus, or blisters.

Neurologic Disorders
Headaches, concussions, and seizures. A recent history of concussion is different than a remote history of concussion, but there is no consensus about the appropriate evaluation of patients who have had multiple remote concussions. Neuroimaging and neuropsychological testing can be used to evaluate athletes with recent or remote concussions. If the concussion was recent, the athlete should be held out of sports until he or she has no symptoms with exercise.(10)

Heat Illness

Use of Special Equipment

Asthma and Seasonal Allergies
Asthma is the most common chronic illness of adolescents. Of those affected, 85% have exerciseinduced bronchospasm. The prevalence of exercise-induced bronchospasm is believed to be 10% to 35% of athletes. It should be suspected in any athlete who has a history of wheezing during sports.(11)

Eyes
The athlete should have adequate vision for the sport. The history and physical should also determine if the athlete is functionally one-eyed, defined as having less than 20/40 corrected vision in one eye.

Musculoskeletal System
Sprains, strains, fractures, and dislocations that required treatment or rehabilitation. Musculoskeletal injury patterns of concern vary by sport. Fractures and ligament injuries are more common in high-contact or collision sports. Low-contact or endurance athletes are more likely to have a history of overuse injury, tendonitis, or stress fractures.

Weight Concerns
Eating disorders or problems with body perception are most prevalent in sports that have weight classes or emphasize appearance or leanness for improved performance. Some studies have shown that as many as 62% of female athletes have an eating disorder.(12)

Psychosocial Issues
Alcohol, drugs, tobacco, steroids, and sexual practices.

Immunizations
The athlete should be current on immunizations against tetanus, measles, hepatitis B, and varicella.

Menstruation
Primary amenorrhea (absence of menses by age 16) or secondary amenorrhea (absence of menses for more than three cycles) suggests the female athlete triad (eating disorder, amenorrhea, and osteopenia).