Preparticipation History&Physical

Preparticipation Physical

December 7, 2013

These forms can be broken down into what the player can provide to enhance their health outcome and what information on the athlete that we, as providers, can gather to either predict or intervene on.  Ideally these forms should be electronic, and have athletes fill them out online or on your computer.

1) Player:

A) Demographics:

This part of the form seems straight forward and common sense, but is absolutely essential from a team physician perspective.

When your team is travelling or your dealing with athletes from a distant having as many contact details (email, home number, cell phone, emerge contacts), health card number, insurance number, DOB, address, other physicians names is essential.  These allow you to fill out forms on their behalf, order imaging, tests, and direct health remotely.

This should include consent to the exam and use of information for further treatment while with the team/organisation.

B)  Past medical history:  

The athletes vary in their attention and interest in filling out these forms, nonetheless they can be critical in identifying issues that would have been otherwise missed.  Whether professional (NHL, CFL, MLS) or amateur  (OHL, varsity/college athletes)  the players should present to the physical examination with the demographics and the past medical history form filled out.   This is essentially a review of systems and an orthopaedic/sports medicine review.

i)  Medical Review of Systems

Past Concussion assessment: for each concussion note: (date, mechanism of injury, loss of consciousness, post concussive amnesia)
Heat-related Incidents:  syncope, dizziness, cramping, disorientation, prolonged recovery, visual changes
Cardiovascular:  Syncope, arrhythmias, heart murmurs, cardiomyopathy, raised blood pressure (see Bethesda http://www.cardiosource.org/~/media/Files/Science%20and%20Quality/Guidelines/Clinical_Documents/BethesdaConference36.ashx)
Respiratory:  Asthma, coughing spells, shortness of breath
GI:  IBD, IBS, exercise-induced diarrhea
Renal:  History of kidney disease, blood in urine, dark urine, frequent urination
Endocrine:  Hypopituitary, DM, Thyroid)
Neurological:  Encephalitis, meningitis, headaches, migraines, seizure disorder/epilepsy (these all predispose to prolonged symptoms with concussion)
Ophthalmology – contacts/glasses – prescription,
ENT – Prior surgeries, recurrent sinus infections, hearing deficits
Derm – rashes, skin conditions (psoriasis, atopic dermatitis), treatments
ID – Hx of Mono, STIs, Hepatitis, HIV, Chicken pox, Shingles, Herpes (esp. wrestling/close contact sports), MRSA
Mental Health: History of anxiety, depression, post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD), schizophrenia
Medications:  Specify medications and inhalers (players often don’t think of inhalers as medication)  Use GlobalDRO, WADA to check medications
Allergies: Medications and Food! (very important for team travel)
Family History:
Sudden Cardiac death (Has anyone in your family died suddenly or before the age of 50?), cardiomyopathy, Marfan’s, QT syndrome
Inflammatory Arthritis, autoimmune conditions
Vaccination History:  MMR, varicella/chicken pox, Diptheria, Pertussis, Tetanus, Typhoid, Polio, Hepatitis B, Meningococcal, Influenza

ii) Sport medicine/Orthopedic review:  Divided into anatomical location
Neck, shoulder, arm, elbow, wrist, hand, hip, groin, knee, ankle, foot.
Questions about prior injuries (date, mechanism of injury, diagnosis, treatment (surgery v. conservative), time of recovery/out of sport

 2) Provider/Team Physician:  This is usually broken into 3 parts:

1) Review of the information provided by the athlete and completing blank parts, and clarifying any pertinent positives.
2) Medical examination – Height, weight, Blood pressure, ENT exam, Cardiorespiratory exam, abdominal exam, hernia, testicular exam, dermatological screen, neurological screen
3) Orthopedic/Sport Medicine exam (Neck, shoulder, elbow, wrist, hand, hip, groin, knee, ankle, foot)
Basic testing for all joints include Inspection, Palpation, Range of Motion (active and passive) Strength testing (Active range of motion v resistance)
Shoulder add impingement testing and apprehension.
Elbow – UCL testing
Hip – FAI testing (FADIR, FABER), adductor testing
Knee – effusion, ligamentous testing (ACL MCL PCL LCL)
Ankle – effusion, ROM, balance, propriocetpion (CFL, ATFL)
Other considerations:

It is possible and advised to add a baseline Balance Error Scoring System to this part of the exam for concussion baseline, along with 3 word immediate and delayed recall)  Baseline neuropsychological testing could be considered as well for concussion management.

Dr. Neil Dilworth CCFP Dip Sport Med

References:

(1) Brukner P. Clinical sports medicine. Rev. 3rd ed. ed. Toronto: McGraw-Hill; 2009.

(2) Chan K, Micheli L, Smith A, Rolf C, Bachl N, Frontera W, et al. F.I.M.S. Team Physician Manual. ; 2006. p. 14-15-32.

(3) Bethesda 36th Conference:  Eligibility Recommendations for competitive athletes with Cardiovascular Abnormalities: http://www.cardiosource.org/~/media/Files/Science%20and%20Quality/Guidelines/Clinical_Documents/BethesdaConference36.ashx

(4)  Global Drug Reference Online:  http://www.globaldro.com/ca-en/

(5)  World Anti-Doping Agency:  http://www.wada-ama.org

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