Sports Medicine, Musculoskeletal, and Exercise-Related Concerns
Preparticipation and concussion
The preparticipation examination focuses on cardiac symptoms, prior concussion, musculoskeletal injury, heat illness, and substance use. Ask about syncope, chest pain, palpitations, and family history of sudden cardiac death. Concussion is a clinical diagnosis: headache, dizziness, confusion, amnesia, nausea, and sensitivity to light or noise. Remove from play immediately; no same-day return. Use gradual return-to-learn then return-to-play.
Musculoskeletal and exercise
Overuse injuries include Osgood-Schlatter, Sever disease, and Little League shoulder. Apophysitis is common during growth spurts. Sprains are managed with protection, relative rest, ice, compression, elevation, and early mobilization. Relative energy deficiency in sport (RED-S) affects both sexes and can cause amenorrhea, stress fractures, and fatigue.
Traps
A normal radiograph does not exclude a growth plate injury. Do not order MRI first for typical Osgood-Schlatter. Do not allow same-day return after concussion. Do not miss the female athlete triad or RED-S. Cardiac screening does not detect all causes of sudden death.
Worked example
A 14-year-old soccer player has anterior knee pain at the tibial tubercle, worse with jumping. Examination shows localized tenderness without effusion. This is Osgood-Schlatter; treat with activity modification, strengthening, and reassurance, not immobilization.