Medical and Medical-Orthopaedic Conditions in Athletes
Cardiopulmonary
Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young US athletes, with anomalous coronary arteries, arrhythmogenic cardiomyopathy, and ion-channel disease also important. Commotio cordis is ventricular fibrillation from a blunt precordial blow during repolarization and requires immediate defibrillation. Exercise-induced bronchoconstriction responds to pre-exercise beta-agonist; paradoxical vocal cord dysfunction causes inspiratory stridor, is refractory to bronchodilators, and is managed with speech therapy.
Infectious disease
Infectious mononucleosis carries splenic enlargement and rupture risk, peaking in the second and third weeks. Most guidance allows noncontact activity after roughly four weeks from symptom onset once fever, pharyngitis, and fatigue have resolved; contact sport return should await clinical recovery and, when symptoms persist, imaging. Skin infections follow clearance rules: tinea and impetigo typically require 72 hours of appropriate therapy, herpes gladiatorum requires about five days of antiviral therapy with no new lesions and all lesions crusted, and suspected MRSA needs drainage and culture.
Endocrine and hematologic
Type 1 diabetes requires adjusted carbohydrate intake and glucose monitoring around exercise, since insulin sensitivity rises. Sickle cell trait predisposes to exertional collapse and rhabdomyolysis; gradual acclimatization, hydration, and work-rest cycles are protective. Iron deficiency is common in endurance athletes and limits performance before anemia appears.
Traps
- Assuming a febrile athlete can compete once afebrile.
- Missing splenic risk by returning a mono patient at two weeks.
- Attributing all exertional dyspnea to asthma.
Rule of thumb: any athlete with syncope or exertional chest pain is restricted until cardiac evaluation is complete.