Preparticipation Examination of the Adolescent Athlete: Part 2

Jordan D. Metzl, MD* 1. 2. *Medical Director, The Sports Medicine Institute for Young Athletes; Assistant Attending Physician, Sports Medicine Service, Hospital for Special Surgery, New York, NY. Objectives After completing this article, readers should be able to: 1. Perform a sport-specific medical and musculoskeletal examination. 2. Explain why it is important to define pre-existing injury patterns. 3. Characterize preventive conditioning and rehabilitation programs for young athletes. This is the second of two articles dedicated to the preparticipation examination of the adolescent athlete. The first article addressed the medical and family history, and this article discusses the medical and orthopedic portions of the examination. The medical examination portion of the preparticipation examination (PPE) should serve both as a follow-up for concerns raised in the medical and family history portion of the examination and as a screening for any medical conditions that might limit safe sports participation. The medical examination begins with measurement of the vital signs, height, weight, blood pressure, heart rate, pulse, and respiratory rate. Blood pressure in the adolescent patient is an important marker for the presence of underlying, silent pathology, including primary hypertension or hypertension due to renal, endocrinologic, cardiac, or central nervous system causes. Secondary hypertension also can result from anabolic steroid use. Blood pressure should be measured with the bladder encircling at least two thirds of the arm. The most common cause for an abnormal value is improper cuff sizing. If the initial value is elevated, two subsequent readings should be obtained before diagnosing hypertension. The guidelines regarding adolescent hypertension are listed in the Table⇓ . Of note, grade III hypertension requires removal from athletics until control is achieved, and grade IV hypertension is a contraindication to sports participation. View this table: Table 1. Values for Adolescent Hypertension Once vital signs are established, the general medical examination should focus on sports-readiness. General markers for health are important, particularly excessive thinness or obesity and phenotypic manifestations of multisystem illnesses such as Marfan syndrome. Contagious skin conditions, including impetigo, molluscum contagiosum, and …