Many parents view the high school sports physical as an inconvenience.

 

One more thing to do in their busy schedule. If it is done thoroughly and properly the physical is not merely a rubber stamp allowing their child to play sports. It can be an assurance that their child IS health and safe to undertake the rigors of their sport.

 

First in the exam are the vital signs.

 

It is important to be sure that the heart rate, respirations, and blood pressure are in a normal range. Vision should also be checked as many of the athletes do not have yearly physicals. This may be the first time they are found to have poor vision.
 

Examining the head and neck both pupils should be of equal size, and react briskly and equally when a bright light is shown in the eyes.

 

It is said that 10-20% of the general population have a benign condition called physiologic anisocoria whereby one pupil is noticeably larger than the other. If present, the athlete and parents should be made aware of this. Should the child sustain a concussion during his sport, this will be an important bit of information for the evaluating physician to know as the athlete is examined on the sidelines. It will help determine what work-up may be indicated and may prevent unnecessary brain scans.

 

The thyroid gland should be felt for assurance that it is not enlarged and that there are no cysts or abnormal masses present.

 

Listening to the heart assures that there are no murmurs, skipped or abnormal beats. Examining the lungs there should be good air entry in both lungs with no wheeze or coarse breath sounds. It is important to document that the liver and the spleen are not enlarged upon examining the abdomen with no masses present.
 

The genital exam is one that causes much angst and nervousness among most teenage boys.

 

But it is important to be sure that the signs of pubertal development are consistent and appropriate for the chronological age. (pubic hair and testicular size). While everyone knows about the Index finger test for hernias an assurance that there are no hydroceles or varicoceles is necessary. A hydrocele is a fluid filled sac within the scrotum that rarely causes problems and can usually just be watched. This should be documented and followed by the primary doctor. A varicocele represents enlarged veins that sit on top of the testicle. Upon examination they feel like a bag of worms. They do not cause pain or symptoms but can impede normal blood flow to the testicle. This may cause a decrease in sperm quality as well as production and could lead to infertility. This should be followed up by a Urology referral.

 

Lastly, all of the joints should be examined to be sure they are stable with good range of motion. Finally, the spine is checked for scoliosis.

 

Some of the basketball or volleyball players are extraordinarily tall and thin. When examining these individuals I always looked for signs of Marfan’s Syndrome. This is a genetic disorder that occurs in about one in 3000-5000 people. This disorder affects the proteins that make up our connective tissue which leads to classic findings on exams. These individuals are very tall, usually thin and gangly. They have long and spindly fingers (arachnodactyly), and long extremities relative to their trunk. They usually have lax and hyper mobile joints.

 

They present with a wrist sign, whereby when the thumb and little finger are wrapped around the wrist, the thumb will cover the nail of the little finger. They also will have the thumb sign (Steinberg sign) whereby when the thumb is folded across the palm, it extends well beyond the palm.
 

People with Marfans may have specific abnormalities that must be looked for. The eyes may be involved causing a dislocated lens, detached retina or even glaucoma.

 

They MUST be referred to an Ophthalmologist. Marfans often will affect the heart which causes a dilation of the aortic root as it comes off of the ventricle. This could lead to an aneurysm or cause leaky heart valves (most commonly mitral valve prolapse). When one suspects Marfan’s Syndrome they should be seen by a Cardiologist and have a thorough work-up including a cardiac echocardiogram. People with Marfans often have some chest wall deformities whereby the rib cages seem inverted or caved in (precuts excavatum). Many with Marfans will also have scoliosis. If not, historians have argued back and forth whether Abraham Lincoln may have had Marfan”s Syndrome. There are certainly players in the NBA that have the syndrome.
 

I am, and have been the team doctor for the St. John Bosco high school football team for the past 27 years.

 

I was the team doctor for St Anthony’s highschool football team for the 5 years preceding that. I have done my share of sports physicals over these 32 years. While it does not happen often that one finds some abnormality on a routine sports exam, it does happen frequently enough that the examining physician MUST be thorough and complete. When something is found early, before any problems have arisen, it is most rewarding to the physician because the well-being or the young athlete is what it is all about.