Musculoskeletal Findings Following Pre-Participation Screening in Young Athletes: A Retrospective Observational Study

Background: Pre-participation screening (PPS) is widely used to evaluate athletes before sport participation, traditionally focusing on cardiovascular risk prevention. However, musculoskeletal assessment performed during PPS may also allow early identification of biomechanical and structural abnormalities that can affect sport participation during growth. Objectives: This study aimed to describe the prevalence, clinical characteristics, and management pathways of musculoskeletal alterations detected during PPS in young athletes, with particular focus on referral patterns to pediatric Physical Medicine and Rehabilitation (PM&R) specialists. Methods: This retrospective observational study included athletes aged ≤15 years who underwent PPS between January 2022 and December 2023 at the Sports Medicine Unit of Noale (ULSS 3 Serenissima, Venice, Italy). Musculoskeletal screening was systematically performed during PPS. Athletes presenting newly detected abnormalities were either managed conservatively by the sports physician or referred for PM&R evaluation. Clinical indications for referral, imaging investigations, diagnoses, and treatment strategies were analyzed. Results: A total of 707 athletes underwent PPS during the study period. After applying exclusion criteria, 635 athletes were eligible for analysis. Musculoskeletal alterations were identified in 141 athletes (22.2%). Among them, 54 athletes were referred for PM&R evaluation and 40 completed the consultation. No statistically significant differences were observed between referred and non-referred athletes. The most frequent reasons for referral were suspected scoliosis (n = 22), foot alignment disorders n = 18), thoracic hyperkyphosis (n = 5), and lower limb length discrepancy (n = 4). Specialist evaluation resulted in conservative management in most cases, including corrective exercise programs and orthotic interventions, while one athlete required surgical treatment for congenital scoliosis. Conclusions: Musculoskeletal screening during PPS identified a broad spectrum of findings in young athletes, including clinically relevant abnormalities requiring specialist evaluation and management. These findings suggest that musculoskeletal assessment may provide an opportunity for early clinical identification within PPS; however, prospective studies are needed to evaluate diagnostic accuracy, long-term clinical benefit, injury prevention, and cost-effectiveness before routine implementation can be recommended.