The physically-challenged athlete: medical issues and assessment.

The rate and pattern of injuries is similar in both physically-challenged and able-bodied athletic participation. However, understanding of the unique medical issues faced by physically-challenged athletes is necessary in conducting appropriate pre-participation evaluations and developing strategies for injury prevention and medical management. Review of the literature provides insight for choosing relevant tests and interpreting components of the physical examination for this population. More research is needed in the management of medical problems specific to the physically-challenged athlete.

Common injuries in the child or adolescent athlete.

As more primary care physicians enter the field of Sports Medicine, they will inevitably encounter more injured young athletes than what they may have experienced in their private practices. Recognizing the differences that exist between the young athlete and adult is essential in properly diagnosing and rehabilitating these athletes. As mentioned in our previous article (Caring for the School-Aged Athlete, Primary Care, December 1994), comprehensive care of the young athlete can be quite involved and somewhat different from care of the adult population. This article focuses on some specific injuries unique to younger, skeletally immature athletes, while mentioning the differential diagnosis of some of the other common sports injuries shared by both younger and older athletes.

Caring for the school-aged athlete.

Younger athletes are participating in more activities today than ever before. The primary care physician needs to fulfill the role of guiding these athletes into their activities safely with recommendations to help prevent injuries and other health conditions that may occur during their training and participation. Knowledge covering preparticipation examinations, cardiovascular concerns, nutrition, maturation, and general rehabilitation of injuries will be necessary for the care of these younger athletes. This article provides a general overview of these areas.

Exercise-induced asthma and anaphylaxis.

With increased popularity in exercise, the number of individuals with exercise-induced asthma (EIA), or 'exercise-induced bronchospasm', has increased due to an increased awareness among physicians of the clinical symptoms associated with EIA. EIA affects approximately 75 to 95% of asthmatic patients. 40% of children with allergic rhinitis have EIA, whereas only 3 to 11% of nonasthmatics have EIA. Although athletes with asthma have been recognised for years, EIA in nonasthmatic individuals has gained recognition since the 1984 Olympics. Vague symptoms of recurring poor performance, fatigue despite adequate conditioning, or 'getting winded' during an athlete's usual workout may be the presenting complaints. Athletes may be more likely to attribute these symptoms to poor conditioning or an upper respiratory infection, and not seek immediate assistance. Younger athletes may complain of stomach ache or refuse to participate in strenuous play because of an inability to keep up with other children. Additionally, an awareness of exercise-induced anaphylaxis needs to be considered when discussing aspects of airway compromise following exercise; however, its presentation is more urgent than those with EIA. Although the pathophysiology of EIA is somewhat controversial, the most likely explanation is a combination of heat and water loss leading to mediator release. The different medications that have been used to treat EIA are based on theories regarding the bronchial hyperreactivity of EIA.

The Vannini-Rizzoli orthosis: a unique case of thoracic outlet syndrome.

The Vannini-Rizzoli boot is a stabilizing orthosis that allows selected spinal cord injured patients to stand and ambulate. The body positioning required to maintain stability while using these boots can result in an exaggerated "military position" of the shoulders, as the patient braces his shoulders posteriorly to maintain his center of gravity anterior to the ankle axis. This posture produced thoracic outlet compression in this patient. This case emphasizes the need to be aware of this clinical complex when working with this orthosis and suggests the importance of the patient's functional needs in treatment decisions.