I just finished a sports med rotation so I can comment on some of your questions. First of all, sports med would be more accurately called musculoskeletal medicine because most of the patients you see do not have sports related injuries, the have MS problems. The vast majority of musculoskeletal problems can be managed nonoperatively. I probably only saw a handful of patients during the entire month that needed an orthopedic evaluation. MS complaints are incredibly common--think about the prevelance of low back pain--and family med docs are not adequately trained in the diagnosis and treatment of these conditions. Think about the number of times on your family med or EM rotation when you saw people with MS complaints--generally you rule out serious pathology, then determine it is MS in nature, and prescribe some NSAIDs, muscle relaxers, and maybe some home exercises... and surprise they never get better.
Sports med docs almost never use muscle relaxers, and use NSAIDs only for very specific indications. They work very closely with PT to rehabilitate patients and they use the underlying pathology of the condition to guide treatment--for example, tennis elbow commonly called lateral epicondylitis actually has no inflammatory component when seen histologically; it's more appropriate to call it a tendinopathy than tendinitis; so antiinflammatory treatment has almost no role. Instead sports med docs will try to directly damage the scar tissue in the tendon which is the underlying problem and correctly rehabilitate the injury to allow proper healing. There are many different means to doing this but some include: prolotherapy, needle tenotomy, deep tissue massage + PT.
They do a decent amount of procedures, including lots of knee and subacromial injections as well as epidurals. Ultrasound is being used much more commonly to diagnose MS inflammation, tears, and calcifications as well as guide therapeutic injections. Common problems include disk herniations, spinal stenosis, tennis and golfers elbow, carpal tunnel, de Quervians, bicep tendonitis, shoulder impingement syndromes, rotator cuff and labral tears, knee osteoarthritis, meniscal tears, acl/mcl tears, petallofemoral syndromes, and plenty of other nonoperative sprains, strains, and fractures.
A typical day is seeing patients in clinic all day. Lots of injections. You become very skilled at the MS examination, reading lots of plain films and MRIs. And most have affiliations with local sports organizations whether professional or colleigate or private. So some afternoons and nights are spent attending games, training, practice, etc. The patients are varied with a good mix of young and old, athletic to immobile.
From what I was told by several sports med attendings, the problem with EM people doing sports med is that they will make a lot more money in the ED. So inevitably most of these people choose to do a few shifts a week in the ED rather than run a busy clinic. For fam med however, it is a pay raise, so most of those guys do exclusively sports med, although some like to keep some fam med patients because they enjoy family med. Your training however would be completely adequate if you did an EM residency. There is no real advantage to doing a FM or PMNR residency instead. And as another poster noted, ortho guys like surgery and hate clinic for the most part.. so it should be no problem finding a position handling exclusively nonoperative problems.
It's a small field but there should be more of these docs out there.. MS complaints are one of the few that require a patient to see a surgeon first.. If you are having headaches, you see a neurologist before you see a neurosurgeon.. BRBPR sees a GI specialist, not a colorectal surgeon.. CP sees a cardiologist, not a CT surgeon, and so on.. But if you have MS pain you are referred to an orthopedic surgeon instead of a MS specialist.. It's a paradigm that needs some shifting.
PM me if you have anymore questions.
