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Sports Physicals

Preparticipation Physical Exam

  • see Preparticipation Pysical Evaluation, ed 3. Minneapolis, MN, McGraw-Hill 2004.
  • AAFP PPE information

Diastolic Heart Murmer

  • incidence of cardiac valve lesions is high requiring evaluation by internists / cardiologist.

Down's Syndrome Athletes

  • require cervical spine radiographic (lateral flexion/extention views) screening before athletic competition. (Birrer RB, Clin Pediatr 2004;43:777).
  • Normal Atlanto-Dens Interval (ADI) is up to 4mm. Patients with Downs Syndrome and an ADI >5mm should not participate in contact sports or sports with a high risk of neck injury (diving, gymnastics, high jump or butterfly stroke) (Pediatrics 1995;96:151)
  • 15% of children with Down's have atlantoaxial instability, 45% have congenital heart disease.

Monocular Athletes

  • require eye protection for any athletic competition.


  • patients with a solitary kidney are at a theoretical risk of injury to the solitary kidney from contact sports. Sports relelaed nephrectomies have been reported for injuries sustained in sledding, skiing, rollerblading and equestrin activity.
  • Kidney injury in team sports is rare.
  • Patients with solitary kidneys should be council about the risks of playing contact sports, and allowed to participate as long as the understand the risks.
  • Johnson B, J Urol 2005;174:689
  • McAleer IM, J Urol 2002;168:1805

Screening Questions

  • History of dizziness with competition is closely correlated with sudden death during sports.

For info on Medical conditions affecting sports see: Risser WL, Pediatrics 1994;94:757.


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