Millers - Sports Medicine - Section 8 Medical Aspects Of Sports Medicine

Front 1

Preparticipation Physical Examination

Back 1

The orthopaedic history questionnaire is the most helpful for identifying musculoskeletal problems. A family history of sudden cardiac death or any personal history of exertional chest pain or dyspnea requires further evaluation and cardiac workup.

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Types of Muscle Fibers

Back 2

There are three types of muscle: I, IIA, and IIB. Muscle of type I is slow twitching/aerobic and is helpful in endurance sports. Training can increase the number of mitochondria and increase capillary density. Muscle of types IIA and IIB is fast twitching/anaerobic and is helpful for sprinters. These muscles have high contraction speeds, quick relaxation, and low triglycerine stores. The mode of energy utilization differentiates type IIA from type IIB muscle: IIA has both aerobic and anaerobic capabilities, whereas IIB is primarily anaerobic. Immobilization of muscle results in a shorter position with a decreased ability to generate tension.

Front 3

Benefits of Exercise

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—Done on a regular basis, exercise can decrease heart rate and blood pressure (hypertension), decrease insulin requirements in diabetics, decrease cardiovascular risk, and increase lean body mass. It has also been shown to reduce cancer risk, osteoporosis, and hypercholesterolemia.

Front 4

Aerobic threshold and conditioning

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—The aerobic threshold can be determined by measuring oxygen consumption and is useful for evaluating endurance athletes. Sports-specific conditioning involves aerobic and anaerobic conditioning in different proportions, based on the season and the sport. In the off-season, long-distance runs can enable sprinters to increase aerobic recovery capability after sprints. Several exercise categories have been described. Stretching has also been shown to have a beneficial effect (Table 4–20).

Front 5

Isometric exercise: Description and Benefit

Back 5

Muscle tension without change in unit length

Muscle hypertrophy; not endurance

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Isotonic exercise: Description and Benefit

Back 6

Weight training with a constant resistance through arc of motion

Improved motor performance

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Isokinetic exercise: Description and Benefit

Back 7

Weight training with a constant velocity, variable resistance Increase strength;

less time consuming but more expensive

Front 8

Plyometric exercise: Description and Benefit

Back 8

Rapid shortening

Power generation

Front 9

Functional exercise: Description and Benefit

Back 9

Aerobic fitness

Easily performed

Front 10

Delayed-Onset Muscle Soreness

Back 10

This condition often follows unaccustomed eccentric exercise, usually appearing 24-48 hours after the activity. The etiology involves inflammation and edema of the connective tissue, with elevated creatine kinase levels.

Front 11

Sudden cardiac death

Back 11

Usually related to an underlying heart condition, especially hypertrophic cardiomyopathy in young athletes and coronary artery disease in older athletes. Screening that includes electrocardiography can identify this problem early.

Front 12

Commotio cordis

Back 12

—Cardiac contusion from a direct blow to the chest (e.g., in Little League baseball) has a poor prognosis, even when immediately recognized and treated.

Front 13

Hypertrophic cardiomyopathy and cardiac murmurs

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—Diastolic murmurs found on routine examination warrant further cardiac evaluation. Murmurs that increase in intensity with Valsalva maneuvers are consistent with hypertrophic cardiomyopathy. Sports participation is contraindicated in cases of outflow obstruction.

Front 14

Anabolic steroids

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—Derivatives of testosterone are abused by athletes attempting to increase muscle mass and strength and increase erythropoiesis. Adverse effects include liver dysfunction, hypercholesterolemia, cardiomyopathy, testicular atrophy, gynecomastia, and irreversible alopecia. Urine sampling has been the standard for evaluation by the International Olympic Committee.

Front 15

Human growth hormone (HGH)

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—Made from recombinant DNA; illegal use of this drug is common. Athletes attempting to increase muscle size and weight abuse this drug, which has side effects similar to those of steroids as well as hypertension and gigantism. Insulin-like growth factor-1 (IGF-1) has effects similar to HGHs.

Front 16

Prohormones

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—Derivatives of testosterone, dehydroepiandrosterone (DHEA) and androstenedione, have been used as anabolic agents. However, their effects are controversial.

Front 17

Physiologic differences of Female atheletes

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Women are typically smaller and lighter and have higher body fat. Lower maximum oxygen consumption (max O2), cardiac output, hemoglobin, and muscular mass/strength are also important considerations. Other differences contribute to the increased incidence of patellofemoral disorders, stress fractures, and knee ACL injuries in females (especially in basketball, soccer, and rugby).

Front 18

Amenorrhea

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—This problem may be related to a low percentage of body fat and/or stress. The incidence approaches 50% in elite runners and is related to stress fractures (osteopenia) and eating disorders (female athlete triad). Dietary management and birth control pills are helpful in treating this problem.

Front 19

Blunt trauma

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—Can cause injury to solid organs. These injuries may be subtle and require a high index of suspicion. The kidney is the most commonly injured organ (especially in boxing), followed by the spleen (injured in football).

Front 20

Chest injuries

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—Can be serious and require immediate on-field action. Decreased breath sounds and hypotension may signify a tension pneumothorax. Treatment entails placing a 14-gauge intravenous needle in the second intercostal space at the midclavicular line, followed by the placement of a chest tube. Airway obstructions must also be anticipated and treated. Rib fractures may also occur in contact sports. The player usually has “had the air knocked out” of him or her, which is usually related to a problem with the diaphragm.

Front 21

Eye injuries

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—These injuries are best avoided with proper protection. A hyphema (blood in the eye) is associated with a vitreous or retinal injury in more than 50% of cases.

Front 22

Auricular hematomas

Back 22

(“cauliflower ear”), common in wrestlers, should be treated with aspiration and wrapping

Front 23

Tooth injuries

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—The tooth or teeth should be replaced immediately but may be temporarily placed in the buccal fold or in milk if necessary.

Front 24

Heat illness

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—Heat stroke, common during the football preseason, is characterized by collapse, with neurologic deficits, tachycardia, tachypnea, hypotension, and anhidrosis. Treatment involves rapidly cooling the body's core temperature. Heat stroke is the second leading cause of death in football players.

Front 25

Cold injury

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—Rewarm in 110-112?F warm-water bath.

Front 26

Exercise-induced bronchospasm

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—This condition involves transient airway obstruction resulting from exertion. Symptoms include the triad of coughing, shortness of breath, and wheezing. It commonly occurs in cold-weather sports, and the diagnosis is confirmed by a low forced expiratory volume. Inhaled β2 agonists are the first-line treatment.

Front 27

Pneumothorax

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—A chest tube or large-bore angiocatheter must be inserted at the second intercostal space for tension pneumothorax.

Front 28

Deep vein thrombosis (DVT) after knee arthroscopy

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—A 10% incidence of DVT after knee arthroscopy, with 2% being proximal without prophylaxis. It is prudent to treat high-risk patients (older patient age, personal or family history of DVT, concomitant medical illness) with prophylaxis against DVT.

Front 29

On-field bleeding

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The affected player must be immediately removed from play and may not return until the bleeding has stopped and the wound has been covered with an occlusive dressing.

Front 30

Methicillin-resistant Staphylococcus aureus (MRSA) in Athletes

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—Can be a training room disaster because it is spread by direct physical contact and sharing of equipment. It typically occurs around the area of previous skin trauma and is characterized by pustules on an erythematous base. It is treated with trimethoprim-sulfamethoxazole (Bactrim) and rifampin.

Front 31

Human immunodeficiency virus (HIV) in Athletes

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An athlete's HIV status is confidential and by itself is insufficient reason to restrict athletic participation. Wound care in this population is the same as that for all athletes, with the use of universal precautions, application of compressive dressing, and waiting until the bleeding has stopped before a return to play.

Front 32

Infectious mononucleosis in athletes

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—The primary concern for athletic participation in athletes that have been diagnosed with this condition is the risk of spleen rupture associated with it. Participation in contact sports should be restricted for 3-5 weeks, and splenomegaly must have resolved before a return to play.

Front 33

Meningitis in athletes

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—A concern in athletes because of the ease of spread from the “close quarters” environment of the training room. Symptoms include fever, headache, and nuchal rigidity. The evaluation of cerebrospinal fluid (CSF) is important to identify cases of bacterial meningitis.

Front 34

Skin infections in athletes

Back 34

Conditions such as tinea corporis (“ringworm”), herpes simplex, herpes gladiatorum, and impetigo are common in sports such as wrestling that involve close contact among athletes. Treatment is administered with antifungal and antiviral medications, as appropriate. Athletic participation should be restricted until all skin lesions have resolved.

Front 35

Special athletes

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—Special considerations may be necessary for patients with congenital heart disease and Down syndrome. Patients with Down syndrome may have congenital cervical instability, which should be assessed radiographically before sports participation. More than 9 mm atlanto–dens interval (ADI) with flexion and extension views is an indication for surgical fusion.