Musculoskeletal and Sports Medicine
General competencies
1. Perform relevant musculoskeletal history
2. Perform physical evaluation
a. Evidence-based
b. Age-appropriate
c. Activity-specific pre-participation
3. Formulate differential diagnosis
4. Recommend treatment
5. Appropriate subspecialty referrals
6. Communication on musculoskeletal health care
a. Individuals
b. Families
c. Coaches
d. School administrators
e. Employers
Topic Areas
1. For all age groups
a. Joint pain, swelling, erythema
b. Muscular pain, swelling and injury
c. Musculoskeletal trauma
d. Fractures
e. Dislocations
f. Tendinopathy spectrum (tendinitis to tendinosis)
i.
Tendon ruptures (partial and complete)
g. Nerve injuries
h. Bone and joint deformities
i. Bone and joint infections
j. Metabolic bone diseases
k. Compartment syndrome
l. Avascular necrosis
m. Osteoporosis
n. Overuse syndromes
o. Back pain syndromes
2. Pediatric problems
a. Musculoskeletal congenital anomalies
b. Musculoskeletal birth injuries
c. Hip dislocation
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
Congenital hip dysplasia
Legg-Calvé-Perthes disease
Osgood-Schlatter disease
Slipped capital femoral epiphysis
“Clubfoot” (talipes equino varus)
In-toeing (metatarsus adductus, tibial torsion, femoral anteversion)
“Bowleg”(genu varum) and “knock knee”(genu valgum)
Epiphyseal injuries (Salter-Harris classification)
Transient synovitis
Child abuse patterns of injury
Dislocation of the radial head (Nursemaid’s elbow)
Blount disease
Rickets
Osteogenesis imperfecta
Thoracolumbar scoliosis
For each topic area
1. Epidemiology
2. Anatomy
3. Pathophysiology/Etiology
4. Risk factors
5. History and physical exam
6. Diagnosic Tests
7. Differential diagnosis
8. Management
9. Psychosocial implications
Highlighted teaching points
1. Anatomy
a. Normal anatomy
b. Normal growth and development
2. Diagnostic tests:
a. Laboratory tests (e.g Joint fluid)
i.
Indications
ii.
Contraindications
iii.
Interpretation
b. Radiology
i.
Radiographs
ii.
Magnetic resonance imaging
iii.
Computed tomography
3.
iv.
Bone scan
c. Special Tests: indications and applications
i.
Arthrogram
ii.
Myelogram
iii.
Arthroscopy
iv.
Electromyography
v.
Nerve conduction studies
Management
a. Office based musculoskeletal procedures
i.
Joint aspirations and injections
ii.
Indications, limitations, contraindications
iii.
Informed consent
b. Expected course
i.
With therapy
ii.
Without therapy
c. Patient education
i.
Acute problems
ii.
Chronic problems
d. Targeted pharmacologic treatment
e. Supportive/corrective devices
i.
Braces
ii.
Casts
iii.
Splints
iv.
Orthotics
f. Complementary and alternative modalities
g. Prevention
i.
Pre-participation screening
ii.
Conditioning and training
h.
i.
iii.
Injury prevention
iv.
v.
Physical fitness/exercise prescription
Bone loss
1. Nutrition
2. Exercise
3. Pharmacology
Rehabilitation
Indications and components
i.
Physical therapy
1. Cold, heat
2. Ultrasound and phonophoresis
3. Exercises
4. Electrical stimulation (e-stim) and iontophoresis
ii.
Occupational therapy
iii.
Complementary modalities (e.g., osteopathic manipulative
treatment [OMT], massage)
iv.
Psychosocial aspects of trauma
j. Surgery and follow-up care
i.
Internal and external fixation devices
ii.
Artificial joint replacement
iii.
Arthroscopy
k. Sport medicine specific management
i.
Nutrition, fluids, electrolyte and dietary supplements
ii.
Injury prevention
1. Discourage improper techniques
2. Rules:
a. Promote rule changes
b. Rule enforcement
iii.
Proper Equipment and maintenance
iv.
Tapping, strapping and bracing techniques
v.
Assessment of environmental safety
1. Promotion of participant and spectator safety
vi.
Conditioning and training techniques/principles:
1. Aerobic training
2. Anaerobic Training
vii.
Exercise prescription:
1. Healthy individuals:
a. Account for age and sex
2. Chronic illnesses:
a. Diabetes
b. Hypertension
c. Congestive heart failure
d. Asthma
e. Chronic obstructive pulmonary disease
3. Pregnancy
4. Physically or mentally challenged individuals
5. Patients with various cardiovascular conditions
a. Arrhythmias
b. Risk for sudden cardiac death
c. Hypertrophic cardiomyopathy
4.
Sports medicine education:
a. Patients, families, complementary health professionals, coaches and
school administrators
b. Athlete as a patient
i.
Team physician
1. Importance of their presence
2. Role of medical directors
3. Role of on-site medical care for mass sporting events
ii.
Acute Injuries
1. Cervical spine injury
a. Evaluation
b. On field management
c. Transport
2. Concussion/Traumatic Brain Injury
a. Evaluation
b. On field management
3. Intracranial hemorrhage
a. Evaluation
b. On field management
c. Transport
4. Severe Fractures and Dislocations
a. Evaluation
b. On field management
c. Transport
iii.
Sport Specific Consideration for:
1. Ill athletes
2. Injured athletes
3. Specific athlete groups
a. Pre-adolescent Athletes
b. Adolescent Athletes
c. Female Athletes
d. Geriatric Athletes
e. Physically challenged Athletes
f. Student Athletes
g. Recreational Athletes
h. Athletes with chronic disease
iv.
Rehabilitation
1. Oversight
5.
2. Return to play decision making
v.
Exercise induced asthma
vi.
Cardiac screening
1. Exercise related cardiac problems
Exercise related psychosocial problems
a. Exercise addiction
b. Performance enhancing drug abuse
c. Social pressures on athletes
i.
To participate when injured
d. Performance pressures
i.
Common sources
ii.
Methods to alleviate
e. The intermittent exerciser
f. Unmet/unrealized expectations:
i.
Psychosocial implications
ii.
Sources of aid
g. Alcohol and illicit drug use and abuse
h. Eating disorders
References:
1. American Academy of Family Physicians. (2008). Recommended Curriculum
Guidelines for Family Medicine Residents, Musculoskeletal and Sports
Medicine (Reprint No. 278), Leawood, Kansas.