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

Szczepanik, Michelle E. MD1; Heled, Yuval PhD, FACSM2; Capacchione, John MD3; Campbell, William MD4; Deuster, Patricia PhD, MPH5; O’Connor, Francis G. MD, MPH5

doi: 10.1249/JSR.0000000000000040
Environmental Conditions

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 further evaluation and a return to duty determination. We describe the definition, pathophysiology, epidemiology, etiology, and clinical course of ER. In addition, we introduce "high-risk" criteria for ER to assist in identifying individuals needing further testing and work-up. Finally we present a suggested algorithm that details the work-up of these individuals with high-risk ER to help identify underlying conditions that may lead to recurrence.

1Fort Belvoir Community Hospital, Fort Belvoir, VA, 2The IDF Institute of Military Physiology, Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel; 3Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD; 4Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD; and 5Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Address for correspondence: Michelle E. Szczepanik, MD, Sports Medicine Fellow, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060; E-mail:

Copyright © 2014 by the American College of Sports Medicine.