Sports Medicine for Adolescents

Sports Medicine for Adolescents

Sports Medicine for Adolescents

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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. AHA 14-point cardiovascular screening elements
  • 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. Osgood-Schlatter disease vs normal adolescent tibia
    • 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). X-ray of adolescent clavicle fracture

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. REDS: Relative Energy Deficiency in Sport diagram
  • 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.

Practice Questions: Sports Medicine for Adolescents

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Post contusional syndrome includes:

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Flashcards: Sports Medicine for Adolescents

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What is the first sign of puberty in males?_____

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What is the first sign of puberty in males?_____

increase in testicular volume

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