Exertional Rhabdomyolysis: Identification and Evaluation of the Athlete at Risk for Recurrence

@article{Szczepanik2014ExertionalRI,
  title={Exertional Rhabdomyolysis: Identification and Evaluation of the Athlete at Risk for Recurrence},
  author={Michelle E Szczepanik and Yuval Heled and John F. Capacchione and William W. Campbell and Patricia A. Deuster and Francis G. O’Connor},
  journal={Current Sports Medicine Reports},
  year={2014},
  volume={13},
  pages={113–119}
}
Exertional rhabdomyolysis (ER) is a common medical condition encountered by primary care and sports medicine providers. Although the majority of individuals with ER follow an expected and unremarkable clinical course without any adverse long-term sequelae or increased risk for recurrence, in others, the condition can serve as an "unmasker" of an underlying condition that portends future risk. We present two cases of warfighters with a history of recurrent ER who presented to our facility for… 

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References

SHOWING 1-10 OF 24 REFERENCES
Return to Physical Activity After Exertional Rhabdomyolysis
TLDR
After treatment for ER, the provider must risk-stratify the athlete for risk of recurrence, consider further testing, and make the difficult decision on when, if, and under what conditions the athlete can safely return to play.
Exertional Rhabdomyolysis: A Clinical Review With a Focus on Genetic Influences
TLDR
The prognosis for ER is significantly better than that for other etiologies of rhabdomyolysis, but the risk of recurrence after an initial episode is unknown, and guidelines for management are provided.
Rhabdomyolysis in a Collegiate Football Player
TLDR
A case of exertional rhabdomyolysis occurring in a healthy, fit 18-year-old placekicker following a supervised practice session led by the team's strength and conditioning coach is presented.
Exertional Heat Illness, Exertional Rhabdomyolysis, and Malignant Hyperthermia: Is There a Link?
TLDR
Recommendations for treatment and recovery include cooling and administration of dantrolene for MH, cooling and aggressive fluid administration for EHI, and physical rest and aggressive intravenous fluid administrationfor ER.
Acute Exertional Rhabdomyolysis and Triceps Compartment Syndrome During a High School Football Camp
TLDR
The upper arm exercise, possibly exacerbated by heat, led to rhabdomyolysis and compartment syndrome and greater awareness of specific exercise hazards and prevention strategies can minimize risk for clinically significant muscle injury.
Evidence for Susceptibility to Malignant Hyperthermia in Patients with Exercise-induced Rhabdomyolysis
TLDR
The authors recommend performing muscle biopsies for histologic examination and IVCT in patients with ER and screened for genetic abnormalities to shed light on the genetics of MH.
Rhabdomyolysis following Severe Physical Exercise in a Patient with Predisposition to Malignant Hyperthermia
TLDR
The in vitro contracture test is the only method used to determine susceptibility to malignant hyperthermia and should be performed when the diagnosis is suggested on clinical grounds.
Exertional rhabdomyolysis in seven division-1 swimming athletes.
TLDR
Exertional rhabdomyolysis classically occurs in individuals who are physically untrained, but it may occur in young, healthy, and competitive athletes who acutely increase their activity.
Malignant hyperthermia associated with exercise-induced rhabdomyolysis or congenital abnormalities and a novel RYR1 mutation in New Zealand and Australian pedigrees.
TLDR
DNA sequence analysis of each kindred revealed the presence of a common novel mutation that results in an arginine401-cysteine substitution in the skeletal muscle ryanodine receptor gene (RYR1), providing confirmation that the MH/central core disease region 1 of RYR1 is a mutation hot spot.
Exertional rhabdomyolysis and malignant hyperthermia in a patient with ryanodine receptor type 1 gene, L-type calcium channel alpha-1 subunit gene, and calsequestrin-1 gene polymorphisms.
TLDR
Clinical evidence is provided for an association between ER and MH and the possible role for synergistic action among rare variants in the genes encoding proteins crucial to skeletal muscle calcium regulation is discussed.
...
...