ABFM Sports Medicine cheat sheet

Anterior cruciate ligament: most common mechanism is noncontact deceleration with valgus and internal tibial rotation; hemarthrosis within hours suggests intra-articular injury.

Ottawa Ankle Rules: obtain radiograph only if pain in malleolar zone plus bone tenderness at posterior edge of distal 6 cm of either malleolus or inability to bear weight 4 steps.

Ottawa Knee Rules: radiograph if age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex to 90°, or inability to bear weight 4 steps.

Glenohumeral dislocation: anterior is ~95%; assess axillary nerve (deltoid sensation) and perform post-reduction radiograph; recurrence risk highest under age 20.

Meniscal tear: joint-line tenderness and delayed effusion; mechanical locking or true blocking favors surgical referral over degenerative tears.

Achilles tendon rupture: positive Thompson test (no plantarflexion on calf squeeze); 20-25% initially misdiagnosed as ankle sprain.

Femoral neck stress fracture: deep groin pain with pain at end range of hip rotation; MRI is the study of choice when radiographs are negative.

Ankle sprain: lateral ligament complex (ATFL first); functional bracing and early weight bearing outperform immobilization for return to sport.

Exercise-associated collapse: most common cause is postural pooling; if not resolving with supine legs elevated, evaluate for exertional heat stroke and cardiac causes.

Exertional heat stroke: core temperature >40°C with CNS dysfunction; cold-water immersion is the definitive treatment and cooling precedes transport.

Commotio cordis: blunt precordial blow during repolarization (vulnerable window ~10-30 ms before T-wave peak); immediate defibrillation is the key intervention.

Asthma in athletes: exercise-induced bronchoconstriction is prevented by warm-up and pre-exercise short-acting beta-agonist; diagnosis requires objective testing (bronchoprovocation or eucapnic voluntary hyperpnea).

Concussion: no same-day return to play; graded symptom-limited stepwise progression with 24 hours between steps; prolonged recovery warrants multidomain assessment.

Sickle cell trait: exertional rhabdomyolysis and sudden death risk with heat, dehydration, and altitude; gradual acclimatization and hydration are preventive.

Infectious mononucleosis: splenic rupture risk highest in weeks 2-4; most guidelines restrict collision/contact activity for at least 4 weeks and until clinical resolution.

Hypertrophic cardiomyopathy: leading cause of sudden cardiac death in young athletes; syncope with exertion and family history of sudden death are red flags.

FITT-VP framework: Frequency, Intensity, Time, Type, Volume, Progression; aerobic guideline is 150-300 min/week moderate or 75-150 min/week vigorous intensity.

Maximal heart rate estimate: 220 minus age; more accurate equations (Tanaka: 208 − 0.7 × age) reduce error in older adults.

Karvonen method: target HR = (HRmax − HRrest) × %intensity + HRrest.

MET: 1 MET = 3.5 mL O2/kg/min; moderate activity is 3-5.9 METs and vigorous is ≥6 METs.

Resistance training: 2 or more days per week targeting major muscle groups; 2-4 sets of 8-12 repetitions at 60-70% 1RM for general fitness.

Detraining: measurable VO2max decline begins within 2 weeks of bed rest; strength losses lag endurance losses.

Heat acclimatization: 10-14 days of progressive exposure expands plasma volume and lowers sweat sodium; benefits decay within 1-2 weeks of cessation.

Altitude: acute exposure lowers VO2max roughly 1-2% per 300 m above 1500 m; live-high/train-low exploits acclimatization without losing training intensity.

Primary survey sequence: airway, breathing, circulation, disability, exposure; catastrophic cervical spine injury is assumed until proven otherwise in unconscious collision athletes.

Sudden cardiac arrest: high-quality chest compressions at 100-120/min, depth 5-6 cm, and early AED use; survival falls roughly 10% per minute of delay.

Spine immobilization: manual in-line stabilization with log-roll or scoop transfer; helmet and shoulder pads removed together or left together to preserve alignment.

Anaphylaxis: intramuscular epinephrine 0.3-0.5 mg (1:1000) in the mid-anterolateral thigh, repeated every 5-15 minutes as needed; antihistamines are adjuncts only.

Exertional hyponatremia: suspect with confusion, vomiting, or seizure in an athlete with excessive fluid intake; treat with hypertonic saline, not free water.

Lightning safety: the 30-30 rule - suspend play when flash-to-thunder is under 30 seconds and wait 30 minutes after the last thunder.

On-field airway: jaw thrust is preferred over head-tilt in suspected cervical injury; use bag-valve-mask with supplemental oxygen.

Return-to-play after emergency: any athlete with syncope, chest pain, or unexplained collapse requires cardiology evaluation before resumption.

PPE core elements: personal and family history, prior injuries, medications and supplements, cardiovascular symptoms, and physical examination including cardiac and musculoskeletal screening.

AHA 14-point screen: focuses on exertional chest pain, syncope, dyspnea, murmurs, blood pressure, and family history of premature cardiac death.

Physical exam components: blood pressure, femoral pulses, cardiac auscultation (standing and squatting for dynamic murmur), Marfan stigmata, and vision screening.

Screening for sudden cardiac death: history and physical have limited sensitivity; ECG screening remains debated and is not universally mandated in the United States.

Musculoskeletal screen: assess strength, flexibility, and alignment; landing mechanics and prior injury are stronger predictors of future injury than static measures.

Sickle cell screening: status should be known for athletes; exertional sickling precautions apply regardless of trait versus disease.

Concussion baseline testing: not required for clearance; if performed, use age-appropriate validated tools and interpret within the individual's own baseline.

Clearance categories: cleared, cleared with restrictions, not cleared pending further evaluation, or disqualified; documentation of restrictions is part of the record.

Tissue healing phases: inflammation (0-7 days), proliferation (1-4 weeks), remodeling (weeks to months); loading must match phase tolerance.

Progressive loading principle: tendon and bone adapt to controlled mechanical stress; complete rest delays remodeling and reduces capacity.

Return-to-play criteria should be criterion-based, not time-based: pain-free full range of motion, symmetric strength (typically ≥90% of contralateral), and sport-specific function.

ACL reconstruction rehabilitation: early range of motion and quadriceps activation, then strength and neuromuscular training; return typically 9-12 months with functional testing.

Concussion return to sport: stepwise exertion protocol with ≥24 hours per step; if symptoms recur, return to the prior asymptomatic step.

Blood flow restriction training: low-load resistance with cuff occlusion can build strength when high loads are contraindicated; avoid with history of venous thromboembolism.

Anterior knee pain: quadriceps and hip abductor strengthening plus load management; patellofemoral tracking is influenced more by hip and trunk control than by taping alone.

Re-injury risk: prior injury is the strongest predictor of future injury; preseason neuromuscular warm-up programs reduce injury rates in pivoting sports.

Carbohydrate intake: 3-5 g/kg/day for light training, 6-10 g/kg/day for moderate to high endurance training, and up to 12 g/kg/day for extreme loads.

Protein: 1.2-2.0 g/kg/day for athletes; 20-40 g per dose and distribution across the day supports muscle protein synthesis.

Fluid replacement: aim to limit body mass loss to under 2%; replace roughly 1-1.5 L per kg of body mass lost, including sodium for heavy sweaters.

Creatine monohydrate: 3-5 g/day loading or maintenance increases phosphocreatine availability and lean mass; no evidence of harm in healthy adults.

Caffeine: 3-6 mg/kg about 60 minutes before exercise improves endurance performance; higher doses increase side effects without added benefit.

Beta-alanine: 3.2-6.4 g/day for 4 or more weeks raises muscle carnosine and benefits 1-4 minute high-intensity efforts; paresthesia is a common side effect.

Dietary nitrate: beetroot juice provides nitrate reduced to nitric oxide; benefits are greatest in less-trained individuals and submaximal endurance tasks.

Anabolic-androgenic steroids: banned by antidoping rules; adverse effects include dyslipidemia, cardiomyopathy, hepatic injury, and suppression of the hypothalamic-pituitary-gonadal axis.

Youth athletes: resistance training is safe with proper supervision and technique; focus on movement quality before maximal loading.

Adolescent growth: apophyses are vulnerable during growth spurts; traction apophysitis (Osgood-Schlatter, Sever) is managed with load modification rather than rest.

Female athlete triad / RED-S: low energy availability, menstrual dysfunction, and low bone mineral density; screen for disordered eating and treat energy availability first.

Pregnancy: moderate aerobic exercise is recommended for uncomplicated pregnancies; avoid supine exercise after the first trimester and contact sports with abdominal trauma risk.

Older adults: combine aerobic, resistance, balance, and flexibility training; falls prevention programs reduce injury and preserve independence.

Athletes with a single kidney: participation decisions are individualized; collision sports carry theoretical risk, and protective equipment and hydration matter.

Diabetes in athletes: monitor glucose around exercise, adjust insulin, and carry fast-acting carbohydrate; exercise can cause both hypoglycemia and post-exercise hyperglycemia.

Athletes with disability: classification systems govern competition; pressure injuries, thermoregulation impairment, and autonomic dysreflexia are key risks in spinal cord injury.

Preparticipation documentation: record clearance status, restrictions, and required follow-up; a signed form creates a legal record of the decision.

Emergency action plan: written, rehearsed, site-specific, with defined roles, equipment location, and activation of EMS; review annually.

Consent and confidentiality: minors require guardian consent for treatment and disclosure; return-to-play decisions should be communicated to the athlete and family.

Conflict of interest: team physicians owe primary duty to the athlete's health; pressure from coaches or administrators must not override medical judgment.

Documentation of return-to-play decisions: include examination findings, functional test results, and the rationale for clearance or restriction.

Antidoping and therapeutic use: verify prohibited status of medications through the relevant antidoping agency and document therapeutic use exemptions before competition.

Concussion legislation: all states have youth sports concussion laws addressing removal from play, written clearance, and education; requirements vary by state.

Sports medicine team model: physician, athletic trainer, physical therapist, and strength staff coordinate care; clear communication channels reduce errors and delays.