Sports Medicine for Adolescents

Pre-Participation Eval - Fit to Play?

• Objectives: Maximize safe participation, identify life-threatening conditions (cardiac, neurological), counsel on health.
• Core Components:
  • History (Patient & Family):
    • Exertional chest pain, syncope/near-syncope, undue dyspnea/fatigue.
    • Family Hx of premature sudden cardiac death (<50 yrs), hypertrophic cardiomyopathy (HCM), Marfan syndrome.
  • Physical Examination:
    • Vitals (BP, HR).
    • Cardiac: Auscultation (murmurs - dynamic: Valsalva, squatting), femoral pulses, Marfan stigmata.
    • MSK: Symmetry, ROM, strength, joint stability (e.g., Lachman).
    • Consider: Female Athlete Triad.
• Clearance Decision Flow:

⭐ The American Heart Association (AHA) 14-element screening recommendations are crucial for identifying cardiovascular risk in young athletes.

Overuse Injuries - Growing Pains Plus

• Repetitive microtrauma to immature skeleton, common in growth spurts. Activity pain, rest relief.
• Apophysitides (Tendon insertion site inflammation):
  • Osgood-Schlatter: Tibial tuberosity. Anterior knee pain, swelling. Jumping.
  • Sever's Disease: Calcaneal apophysis. Heel pain. Impact activities.
  • Sinding-Larsen-Johansson: Inferior patellar pole. Localized knee pain.
  • Little League Elbow/Shoulder: Medial epicondyle/Proximal humerus. Throwing pain.
• Other Common Issues:
  • Stress Fractures: Tibia, metatarsals. Point tenderness. Initial X-ray may be normal.
  • Shin Splints (MTSS): Diffuse posteromedial tibial pain.
• Management: Activity modification, RICE, NSAIDs, physiotherapy, gradual return to play.

⭐ Osgood-Schlatter (tibial tuberosity apophysitis) is common in active adolescents (10-15 yrs) during growth spurts, linked to jumping sports.

Acute Injuries & Concussion - Sudden Snaps & Head Hits

Acute Injuries:

• Common: Sprains (ligaments), strains (muscles/tendons), fractures.
• Mechanism: Sudden twists, impacts, falls during sports.
• Management: 📌 RICE (Rest, Ice, Compression, Elevation) for soft tissue. Immobilization for suspected fractures.
• Examples: Ankle sprain, ACL tear (knee), clavicle fracture (fall on shoulder).

Concussion (mTBI):

• Cause: Head impact → transient neurological dysfunction.
• Symptoms: Headache, dizziness, confusion, amnesia. SCAT5 for assessment, includes symptom evaluation, cognitive & balance testing.
• ⚠️ Red Flags: Worsening headache, vomiting, seizures, focal deficits, GCS < 15 → urgent referral.

⭐ Any suspected concussion requires immediate removal from play and medical assessment; SCAT5 is a key assessment tool.

Graduated Return-to-Play (RTP) Protocol:

• Stepwise progression; minimum 24h per step. Proceed if asymptomatic.

Special Considerations - Unique Players, Special Alerts

• Female Athlete Triad (FAT): 📌 EMB (Energy, Menses, Bone)
  • Low Energy Availability (EA) ± disordered eating.
  • Menstrual Dysfunction: Amenorrhea/oligomenorrhea.
  • Low Bone Mineral Density (BMD): Osteoporosis/osteopenia.
• Relative Energy Deficiency in Sport (RED-S):
  • Broader than FAT; affects males & females.
  • Multi-system impact: metabolic, immune, CV.

  ⭐ The Female Athlete Triad (low energy availability, menstrual dysfunction, low bone mineral density) has been expanded to Relative Energy Deficiency in Sport (RED-S), affecting male athletes too.

• Chronic Illness in Athletes:
  • Asthma (EIB): Pre-medicate SABA.
  • Diabetes: Monitor glucose; adjust insulin/carbs.
  • Seizures: Controlled = generally safe.
• Environmental Concerns:
  • Heat Stroke: Emergency. Acclimatization key.
  • Cold Injuries: Frostbite, hypothermia.
• Unique Player Alerts:
  • Down Syndrome: Atlantoaxial Instability (AAI) screen.
  • Sickle Cell Trait: ⚠️ Exertional sickling risk. Hydration vital.

High-Yield Points - ⚡ Biggest Takeaways

• Female Athlete Triad: Comprises disordered eating, amenorrhea, and osteoporosis.
• Osgood-Schlatter Disease: Anterior knee pain from tibial tubercle apophysitis in active youth.
• Spondylolysis: Pars interarticularis defect (stress fracture), common in hyperextension sports.
• Concussion: Management involves initial cognitive rest and graduated return-to-play.
• ACL Tears: Higher in females; often non-contact pivoting injuries.
• Shoulder Dislocation: Anterior is most common; high recurrence risk in adolescents.
• PPE (Pre-Participation Evaluation): Essential for screening and identifying at-risk athletes.