ABPMR Sports Medicine cheat sheet

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

Ottawa Ankle Rules: radiograph if malleolar tenderness in specified zones or inability to bear weight four steps; foot series if navicular or base of fifth metatarsal tenderness.

Lachman is the most sensitive physical test for ACL tear; pivot shift is the most specific.

Meniscal tear: joint-line tenderness and McMurray test; locking suggests displaced bucket-handle tear requiring urgent orthopedic evaluation.

Shoulder impingement: Neer and Hawkins tests; supraspinatus strength by Jobe empty-can; biceps by Speed; instability by apprehension/relocation.

Adolescent extension athletes with back pain: spondylolysis suspected; flexion-extension radiographs or MRI; avoid repetitive extension until cleared.

Femoroacetabular impingement: cam deformity at femoral head-neck junction, pincer at acetabular rim; positive FADIR test and reduced internal rotation.

Acute compartment syndrome: pain out of proportion, pain with passive stretch, tense compartment; emergency fasciotomy.

Lateral epicondylitis: pain at lateral epicondyle with resisted wrist extension; medial epicondylitis with resisted wrist flexion.

Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death in young athletes; LV wall thickness ≥15 mm and pathologic ECG changes warrant cardiology evaluation.

Athlete's heart: sinus bradycardia, first-degree AV block, and increased chamber size that normalize with detraining; does not cause pathologic Q waves or marked LVH.

Infectious mononucleosis: avoid contact for about 4 weeks after symptom onset; return when afebrile, energy restored, and splenomegaly resolved.

Sickle cell trait: exertional collapse and rhabdomyolysis risk; gradual acclimatization, hydration, and cessation of activity with symptoms.

Exercise-induced bronchoconstriction: warm-up, inhaled beta-2 agonist before exercise, and avoidance of cold dry air.

Diabetes: exercise lowers glucose; monitor before, during, and after; carry fast-acting carbohydrate; avoid injecting insulin into exercising limb.

Herpes gladiatorum: contagious skin infection in wrestlers; no contact until lesions crusted and cleared; prophylaxis may be considered.

Marfan syndrome: aortic root dilation risk; avoid contact and high-intensity isometric exercise; cardiology clearance required.

Fick equation: VO2 = cardiac output × arteriovenous oxygen difference; cardiac output = heart rate × stroke volume.

Maximal heart rate estimates: 220 − age or Tanaka 208 − 0.7 × age; both have standard deviation of about 10 beats per minute.

One MET = 3.5 mL O2/kg/min; moderate intensity is 3–5.9 METs, vigorous is ≥6 METs.

ACSM aerobic prescription: 150 minutes/week moderate or 75 minutes/week vigorous, plus resistance training twice weekly.

FITT: frequency, intensity, time, type; intensity set by heart rate reserve, VO2 reserve, or RPE.

Chronotropic incompetence: failure to reach 80% of predicted heart rate reserve; associated with exercise intolerance and cardiac events.

Bruce protocol: 3-minute stages increasing speed and grade; used for diagnostic stress testing; stop for symptoms, arrhythmia, or hemodynamic instability.

Lactate threshold: exercise intensity where blood lactate rises; used to prescribe training zones.

Detraining: within 2 weeks, VO2max and stroke volume decline; maintenance requires some continued training.

AHA 14-element screening: personal history, family history, physical exam; focuses on syncope, chest pain, murmurs, and family sudden death.

PPE ideally 6 weeks before season to allow evaluation and rehabilitation.

Positive cardiovascular symptoms: exertional syncope, chest pain, palpitations, unexplained dyspnea; require cardiology evaluation before clearance.

Family history: sudden cardiac death before age 50, cardiomyopathy, Marfan syndrome, long QT syndrome, or pacemaker.

Physical exam includes blood pressure, femoral pulses, heart murmur (especially with Valsalva), Marfan stigmata, and musculoskeletal screening.

Concussion history: number, duration, and recovery; recurrent concussions may require longer return-to-play and specialist evaluation.

Immunizations and heat illness history should be reviewed at PPE.

ACL prevention: neuromuscular training with plyometrics, balance, and strengthening reduces injury, especially in female athletes.

Return to play criteria: pain-free, full range of motion, strength ≥90% contralateral, sport-specific functional testing, and psychological readiness.

Concussion RTP: symptom-limited stepwise protocol, 24 hours per step, with return to contact only after full symptom-free exertion.

Bone stress injury: relative rest, nutritional optimization, and gradual loading; high-risk sites (femoral neck, anterior tibia, navicular, fifth metatarsal) require stricter management.

Tendinopathy: progressive loading (eccentric or heavy slow resistance) is superior to rest alone.

Hamstring strain prevention: Nordic hamstring curls and sprinting mechanics reduce recurrence.

RICE is outdated; PEACE and LOVE emphasize protection, elevation, compression, education, load, optimism, vascularization, and exercise.

10% rule: avoid increasing training volume by more than 10% per week to reduce overuse injury.

Pediatric athletes: growth plate is weaker than ligament; apophysitis (Osgood-Schlatter, Little League shoulder) from repetitive traction.

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

Pregnancy: moderate exercise is safe; avoid supine exercise after first trimester, contact sports, and high-altitude or hot environments.

Spinal cord injury: autonomic dysreflexia above T6; thermoregulation impaired; monitor blood pressure and temperature.

Older athletes: sarcopenia and falls; resistance and balance training improve function and reduce injury.

Sickle cell trait: hydration and gradual acclimatization; stop exercise with pain, weakness, or dark urine.

Adaptive sports: classify by functional ability; monitor skin breakdown and shoulder overuse in wheelchair athletes.

Primary survey: ABCDE; control hemorrhage, check airway, breathing, circulation, disability, exposure.

CPR: 100–120 compressions/min, depth 5–6 cm, 30:2 with rescue breaths; use AED as soon as available.

Anaphylaxis: epinephrine 0.3–0.5 mg IM thigh, repeat every 5–15 minutes; call emergency services.

Exertional heat stroke: cool first, transport second; cold-water immersion is preferred; core temperature >40°C with CNS dysfunction.

Tension pneumothorax: needle decompression before chest tube; second intercostal space midclavicular or fourth/fifth anterior axillary.

Joint arthrocentesis: sterile technique; avoid if cellulitis over site; send fluid for cell count, crystals, culture.

Ultrasound anisotropy: tendon appears hypoechoic when beam not perpendicular; adjust probe angle.

Sports ultrasound: high-frequency linear probe for superficial structures; use dynamic scanning and compare contralateral side.