Inpatient Rehab as a basis for MSK Medicine?!?

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Over the next couple of months is when most newbies get the "PGY-2 blues." Many of you entered into the wonderful field of PM&R with the goal of a strictly outpatient based practice. Inpatient can be very tough for those of you who are have already decided that it's not a career for you. That being said, I suggest looking at inpatient to truly understand musculoskeletal medicine.

One of my biggest pet peeves is when people talk about neurorehabilitation and musculoskeletal medicine as if they are separate populations when they are really still on the same spectrum. There are surprising similarities in your weekend warriors with a rotator cuff injury and your hemiplegic patient with shoulder pain. Are you a sports medicine guy who loves running injuries?!? Please watch your incomplete SCI or your stroke patient's walk. You have to understand how people walk before you can diagnose and treat a running injury.

My advice:
1) Instead of counting down the days until inpatient is over, take this opportunity to practice your physical exam skills. You will actually find a TON of TRUE positive findings in the inpatient population compared to your weekend warriors. Try to hone down what TRUE weakness is on physical exam.
2) Go and watch therapy. Relearn your anatomy and try to figure out what muscles are activating when your patients are moving.
3) Talk with your physical and occupational therapists. Unfortunately, there is not enough emphasis on biomechanics and kinesiology built into the current PM&R didactics. PTs and OTs often have this type of training.
4) Talk with the prosthetists and orthotists. These guys know a TON when it comes to biomechanics.

Good luck with PGY2!!! It's not that bad. As an Spine/MSK guy, I can honestly say I've learned most of what I know about MSK medicine from my inpatient years.

Originally Posted by fozzy40

Over the next couple of months is when most newbies get the "PGY-2 blues." Many of you entered into the wonderful field of PM&R with the goal of a strictly outpatient based practice. Inpatient can be very tough for those of you who are have already decided that it's not a career for you. That being said, I suggest looking at inpatient to truly understand musculoskeletal medicine.

One of my biggest pet peeves is when people talk about neurorehabilitation and musculoskeletal medicine as if they are separate populations when they are really still on the same spectrum. There are surprising similarities in your weekend warriors with a rotator cuff injury and your hemiplegic patient with shoulder pain. Are you a sports medicine guy who loves running injuries?!? Please watch your incomplete SCI or your stroke patient's walk. You have to understand how people walk before you can diagnose and treat a running injury.

My advice:
1) Instead of counting down the days until inpatient is over, take this opportunity to practice your physical exam skills. You will actually find a TON of TRUE positive findings in the inpatient population compared to your weekend warriors. Try to hone down what TRUE weakness is on physical exam.
2) Go and watch therapy. Relearn your anatomy and try to figure out what muscles are activating when your patients are moving.
3) Talk with your physical and occupational therapists. Unfortunately, there is not enough emphasis on biomechanics and kinesiology built into the current PM&R didactics. PTs and OTs often have this type of training.
4) Talk with the prosthetists and orthotists. These guys know a TON when it comes to biomechanics.

Good luck with PGY2!!! It's not that bad. As an Spine/MSK guy, I can honestly say I've learned most of what I know about MSK medicine from my inpatient years.

Well said. The measure of a person's character and work ethic is how much effort they will put into things they do not always like. Kick ass on ALL rotations.

Very nice post Fozzy.

I also learned a majority of my MSK medicine while on traditional "Rehab" rotations. But I learned biomechanics. And that is what makes me a good doctor today.

I am a BCM/UT Houston Grad. Back when I did PM&R, our entire first 2 yrs were inpt except for 3 months of EMG. But we did PM&R clinics, and like Fozzy said, you see a ton of pathology. That is when I learned what "normal" is.