Medical Screening of Elite Athletes - Hong Kong Sports ...
Transcript of Medical Screening of Elite Athletes - Hong Kong Sports ...
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Medical Screening of Elite Athletes
精英運動員醫學檢定
Dr J Wong 黃平山醫生
20-3-2006
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Annual Medical screening A Formality or Necessity?
每年醫學檢定
必需手續 或 例行公事?
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Medical Consultant 顧問醫生
Athletes運動員
HKSI體院
↔ ↔
Medical Consultant 顧問醫生
Co-ordinator協調人
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Medical Consultant 顧問醫生
Responsible for:
Interests of athletes 運動員利益
Physical health 身體健康
Mental health 精神健康
Performance 運動表現
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Medical Consultant 顧問醫生
Responsible for:
Interests of H K S I 體院利益
Administrators 行政人員
Coaches 教練
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Legal responsibilityIdentify athletes at riskImprove performancePromote healthy lifestyle
Medical Screening of Elite Athletes精英運動員醫學檢定
法律責任
找出運動有危險
人仕
改進表現
推廣健康生活
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Annual review 每年檢討Face to face 面對面
2 ways interactive 雙向互動
Let athlete speaks 盡訴內心疑惑
Detect early 盡早找出問題problems
Medical Screening of Elite Athletes精英運動員醫學檢定
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History 病歷
Physical Exam 體檢
Laboratory 實驗室測試investigation
Medical Screening醫學檢定
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Formats 形式
Office-based1º care physicianAssembly linemany athletes by a single physicianMulti-stationmultiple examiners with specific area of examination
家庭醫生
流水作業單一醫生
流水作業多位醫生分項檢查
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Timing 時間
Six weeks before participationCorrection of problemsTreatment of injuries
參加前六星期
改進問題
治療創傷
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Timing 時間
March 三月
Signing new contract 新合約
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Legal responsibilityIdentify athletes at riskImprove performancePromote healthy lifestyle
Medical Screening of Elite Athletes精英運動員醫學檢定
法律責任
找出運動有危險
人仕
改進表現
推廣健康生活
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Legal responsibilityIdentify athletes at riskImprove performancePromote healthy lifestyle
Medical Screening of Elite Athletes精英運動員醫學檢定
法律責任
找出運動有危險
人仕
改進表現
推廣健康生活
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Legal Responsibility 1法律責任
Protection for the 保障有關團體
sports institution & 及總會
governing bodies
Liability of the physician 醫生法律責任
Cannot detect all 不能百份百保
lethal diseases 證安全
Human rights 運動員之人權
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Legal Responsibility 2法律責任
Team physician: authority to disqualify athlete medicallyDiscrimination laws : prohibit unjustified disqualification
隊醫有權取消參賽資格
運動員可用歧視法反對
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Legal Responsibility 3法律責任
1995 Pahulu vs University of Kansas Narrow cervical canal with transient quadriplegia
1996 Knapp Vs Northwestern University 1º ventricular fibrillation & cardiac arrestAutomatic cardioverter-defibrillator implant
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Legal Responsibility 4法律責任
19 yrs male
swimmer
PPPE for China
Inter-city Games
Systolic murmur
十九歲男泳員
城運會賽前體檢
發現心臟有雜音
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Legal Responsibility 5法律責任
Echocardiograph advised but not doneTeam physician: no participationComplain to Ombudsman in Hong Kong
沒有遵從隊醫指示作超音波心臟測試
比賽資格被取消
向投數訴專員投訴
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Legal responsibilityIdentify athletes at riskImprove performancePromote healthy lifestyle
Medical Screening of Elite Athletes精英運動員醫學檢定
法律責任
找出潛在危險運
動員
改進表現
推廣健康生活
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Athletes at risk潛在危險運動員
Death 死亡
Injury 受傷
Disability 殘廢
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Sudden Death in Athletes運動員猝死 1
Exercise does not kill運動不會殺人
↑only in athletes with existingheart disease本身有毛病才會因運動死亡
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Sudden Death in Y Athlete 年輕運動員猝死 2
Van CampNon-traumatic death 1983 – 1993USA high school & college athletes7.47 / million / yr (male athletes)1 death / yr / 133,8681.33 / million / yr (female athletes)1 death / yr / 751,879
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Sudden Death in Y Athlete 年輕運動員猝死 4
All boys
No syncope
No family history of sudden death
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Sudden Death in Y Athlete年輕運動員猝死 5
Causes of death:
Cardiovascular causes 74 %
Non-cardiac 26 %
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Cardiovascular causes 1心臟血管疾病
N = 100Hypertrophic cardiomyopathy (56%)Coronary artery anomaly (16%)Myocarditis (7%)Aortic stenosis (6%)Dilated cardiomyopathy (5%)Atherosclerotic coronary H D (3%)Aortic rupture (2%)
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Cardiovascular causes 2心臟血管疾病
Nonspecific cardiomyopathy (2%)Aortic stenosis (2%)Coronary artery aneurysm (1%)Mitral valve prolapse (1%)R ventricular cardiomyopathy (1%)Cerebellar A-V malformation (1%)Subarachnoid haemorrhage (1%)Wolff-Parkinson-White Syndrome (1%)
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Non-cardiovascular causes非心臟血管疾病
N = 30Hyperthermia (43.3%)Rhabdomyolysis (23.3%)Status asthmaticus (13.3%)Lightning (10%)Arnold-Chiari II malformation (3.3%)G I bleeding & aspiration (3.3%)Exercise induced anaphylaxis (3.3%)Undetermined (23.3%)
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17 yrs female athlete十七歲女運動員
Palpitation, dizziness × 6 months during routine workoutB P 120/60Pulse 70/minSystolic murmur ↑ Valsava manoeuvre
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Sv2 + Rv6 = 55
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Echocardiogram心臟超音波掃描
Grossly hypertrophic left
ventricular wall
Asymmetrical septal hypertrophy
Ant movement of mitral leaflet
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Hypertrophic 心肌肥厚症Cardiomyopathy
Familial disease
Thicken cardiac muscle > 15 mm
Normal cavity size
50 % sudden death
in 10 – 30 yrs
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Genetic cardiovascular diseases
Hypertrophic cardiomyopathy
Long-QT syndrome
Marfan syndrome
Arrhythmogenic R ventricular
cardiomyopathy
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Marfan’s Syndrome馬凡氏綜合征
Mutation of fibrillin gene
Tall statue
High arched palate
Arachnodactyly
Mitral valve prolapse
Aortic regurgitation, aneurysm
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Genetic Cardiovascular D AHA June 04
↑sudden death during exercise
May not stop vigorous exercise with warning signals
Moderate intensity exercise 4-6 MET
Low intensity < 4 MET
Avoid burst exertional, competitive, isometric exercises
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Single Organ單一器官
Eye
Kidney
Testis
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Myopia 近視
SevereRetinal detachmentLight flashing curved image impaired vision
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Liver
Spleen
No contact sports
Enlarged Organs
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Congenital
Acquired
Predispose to injury
Skeletal Problem骨骼問題
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Pectus Carinatum(pigeon chest) 雞胸
Asthma
Congenital heart disease
Normal
Performance not affected
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Pectus Excavatum(funnel chest) 凹胸
↓ chest expansion
↓ vital capacity
↓ performance
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2001 All China Games二零零一中國全運會
31 yrs male boxer
Limping gait
Shorten L lower limb
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2001 All China Games二零零一中國全運會
31 yrs male boxer
Limping gait
Shorten L lower limb
Congenital dislocation of hip
Mild Beta-thalassaemiaanaemia
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31 yrs Boxer 2
Unlimited participation
Not allowed to compete
A I B A
Unlimited participation
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Recurrent ankle inversion injuries
Muscular weakness
Lax ligaments
Joint subluxation
↓ Proprioception
Vigorous rehabilitation
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Genu Varum
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Genu Valgum
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Genu Recurvatum
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Hyperpronation
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Pes Planus
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Flat Foot
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Pes Cavus
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Female Athlete
Amenorrhoea
Eating disorders
Osteosporosis
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Female Athlete
16yrs
primary amenorrhoea
elder sister also has primary
amenorrhoea
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Female Athlete
19 yrs
R inguinal mass
Surgical exploration done
Testicular tissue in hernia
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Male Pseudohermaphroditism男性假雙性人
Male (46XY) karotype
Incomplete masculization
↓ testosterone biosynthesis
↓ 5 alpha reductase:
↓ testosterone to dihydrotestosterone
Androgen insensitivity syndrome
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Sex Reassignment 性別重新指定
IOC allowed to completeBefore pubertyNo time limitAfter puberty2 yrs after complete surgical changelegal recognitionappropriate hormonal therapy
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Legal responsibilityIdentify athletes at riskImprove performancePromote healthy lifestyle
Medical Screening of Elite Athletes精英運動員醫學檢定
法律責任
找出潛在危險運
動員
改進表現
推廣健康生活
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Improve Performance
Technique and equipment
Physical fitness
Psychological state
Social factors
Doping
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Improve Performance
Technique and equipment
Physical fitness
Psychological state
Social factors
Doping
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Physical Fitness體能
Body compositionInitial body weights Ideal for the sports ? Subsequent changes
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Body Composition
↓Body weight
Hyperthyroidism
2 female athletes
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Female Athlete
↑ Body weight
2001 21 yrs 61 kg
2002 22 yrs 65 kg
2003 23 yrs 70 kg
2004 24 yrs 80 kg
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Female Athlete
Headache
Pituitary gland hyper-function
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Physical Fitness
Flexibility
Sit and reach tight lower body
Range of movement
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Flexibility Evaluation
Normal?
Perform movement without undue resistance
Poor flexibility → Injuries
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Hip: Thomas Test
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Hip: Ober’s Test 15°
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Hip: Rotation 90°
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Knee: Hamstring 180°
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Knee: Quadriceps 135°
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Ankle: Gastrocnemius 20°
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Ankle:Soleus 20°
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Ankle: Ant. Compartment Muscles 45°
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Spine Extension
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Physical Fitness
Muscles
Power
Balance
Endurance
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1:00 ant deltoid
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2:00 supraspinatus
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3:00 middle deltoid
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5:00 Post deltoid
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Physical Fitness
Cardiopulmonary function (VO2Max)
Atmospheric O2
Lungs
Heart
Muscles
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Lung Functions
Asthma
↑Airway resistance
FEV in 1 sec PEF
15% ↑ after bronchodilator
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Cardiopulmonary Function
O2 transportBy haemoglobin in RBC
↓Hb→ anaemia
Iron deficiency anaemia
Hereditory anaemia
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Hereditary Anaemia
Thalassaemiaα & β
Common
02/03 13 in 331 (3.9%)
Hong Kong incidence (8.4%)
Mild anaemia + microcytosis
May impair endurance capacity
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Improve Performance
Psychological state
Social factors
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Male Endurance Athlete
17 yrsWants to quit
Always come second
Pressure from parents
Pressure from coach
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Male Endurance Athlete
Persistent epigastric pain
Negative investigation
Not responsive to treatment
Compete with adult athletes
Minimal money to spend
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Legal responsibilityIdentify athletes at riskImprove performancePromote healthy lifestyle
Medical Screening of Elite Athletes精英運動員醫學檢定
法律責任
找出潛在危險運
動員
改進表現
推廣健康生活
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Healthy life style
Smoking
Alcohol
Nutrition
Sex education
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Smoking
Smoking
↓Performance
Health hazards
CHD CVA COAD Lung Cancer
peptic ulcer impotence etc
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Nutrition
Body composition
Anaemia
Healthy diet
Dietician referral
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Sex education
Responsibility
Contraception
Venereal disease
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Hepatitis Immunity Status
Hepatitis A infected via oral route
Hepatitis B via body fluids & birth
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Hepatitis B Carriers
May infect others25% develop complicationNeeds constant monitoringHepatitis A vaccine ChinaHKSAR
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Drug History
Update drugs used by athlete
Conform to WADA current prohibited list
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45 yrs lawn bowling athlete 1
Natrilix (indapamide)
Xanax (alprazolam)
Valium (diazepam)
Stemetil (prochlorperazine)
Ipradol (hexaprenaline)
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45 yrs lawn bowling athlete 2
Natrilix (indapamide)
Xanax (alprazolam)
Valium (diazepam)
Stemetil (prochlorperazine)
Ipradol (hexaprenaline)
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45 yrs lawn bowling athlete 3
Natrilix (indapamide)
Xanax (alprazolam)
Valium (diazepam)
Stemetil (prochlorperazine)
Ipradol (hexaprenaline)
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Performance Enhancement
K Hodges Med Sc in Sp Ex Feb 2006
Double blind randomizedN = 7 1500 M running trialsPseudoephedrine 2.5 mg / Kg 90 min pre-exerciseImprovement of 2.1 %
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Bronchial asthma
Oral bronchodilators not allowed
Beta agonists & steroid inhalation needs prior notification
Laboratory confirmation required for Olympic Games
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Most common medical problems
Refractive errors
Allergic rhinitis
Ear wax
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Recommendation
Full participation
Clearance after a problem is corrected
Clearance after additional examinations
Participation in certain sports
No participation
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Sudden Death in Athletes
Can PPPE prevent sudden death?AHA: history + P E alone cannot detect
many critical cardiovascular abnormalities
HCM 25% have family history
20% have symptoms
75% non-obstructive: soft or no murmur
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Sudden Death in Y Athlete 年輕運動員猝死
Fuller 1997 5615 high school athletesFuller 1997 5615 high school athletesDetection of serious cardiac condition by Detection of serious cardiac condition by History: 0 P E : 6 ECG:16 History: 0 P E : 6 ECG:16 Total 22 withheldTotal 22 withheldAll not related to sudden deathAll not related to sudden death1 with normal history PE & ECG developed1 with normal history PE & ECG developedV F due to anomalous coronary arteryV F due to anomalous coronary artery
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Sudden Death in Y Athlete 年輕運動員猝死
1992 – 1997 68503 Japanese H school students screened for CVD37807 completed 6 yrs follow up9 high risk gp (0.024%)3 sudden deaths (1.32/100,000/yr)1 in high risk gp HCM (1/9)2 in low risk or normal (2/37798)
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Annual Medical screening A Formality or Necessity?
每年醫學檢定
必需手續 或 例行公事?
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Identify some athletes at risk
Prevent some injuries
Help some athletes perform better
Promote a healthy life style
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Feed on food from the emporor
食君之祿
Shoulder the emporer‘s trouble
擔君之憂
How much food you get ?
有幾多祿?
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Thank You