Fine motor skills needed for PM&R procedures

[Deucedano]

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I am really interested in the MSK aspect of PM&R, especially all the procedures. However, I recently started taking medications that give me tremors. They are not present all day, but sometimes can be bad (typing wrong letters). So my question is how much fine motor skill is needed to perform MSK procedures?

 

[lobelsteve]

I'm pretty sure if you came at me with a needle in a shaky hand, I'd stop you.
Sounds like definition of impaired physician.

Psychiatry, pathology, radiology.

I'm guessing stimulant for ADHD.

 

[rysa4]

I am really interested in the MSK aspect of PM&R, especially all the procedures. However, I recently started taking medications that give me tremors. They are not present all day, but sometimes can be bad (typing wrong letters). So my question is how much fine motor skill is needed to perform MSK procedures?

Well lets think about what procedures you are referring to...

1. MSK exam - You should be OK here.
2. Manual Medicine skills - probably OK with most. If you would ever head towards cranio-sacral techniques -- could be an issue.
3. EMG - The needle exam will be a problem qualitatively - there is some real subtlety here with regards to needle handling and tremors would be a major problem in my opinion. It would also disturb your ability to interpret potentially during the exam and you could miss certain audible clues of importance if a tremor caused needle movement.
4. Large joint injections - difficult to assess based on your post. Possible to do.
5. The various lumbar and thoracic injections, including facet joint blocks and SI--major problem and potential liability.

 

[wylie313]

how about taking a low dose beta blocker, problem solved

 

[PMR 4 MSK]

I have a benign familial tremor. Classmates in med school were the first to notice. Concentration and confidence help to keep it at bay. When it really gets going I stop for a few seconds to a minute. Avoid caffeine (as much as it is my favorite drug to abuse, hehe). Eat well and sleep well.

There are methods of steadying your hand during needle procedures. Resting your hand when possible on the pt. Using both hands at the same time. Keeping them as close to your center of gravity as possible.

If it's med-induced, look for an alternative med, or use another (like beta-blocker as above).

 

[Deucedano]

I'm pretty sure if you came at me with a needle in a shaky hand, I'd stop you.
Sounds like definition of impaired physician.

Psychiatry, pathology, radiology.

I'm guessing stimulant for ADHD.

Right about the med but not for ADHD, for narcolepsy/idiopathic hypersomnia.
Unfortunately, there are not many other meds out there that I can use with success. I finally found a combination of medications that work really well for me so I can function like a normal human being for most of the day. However, it comes with the price of having tremors periodically throughout the day. Im sure the additional caffeine on top of the meds isnt helping and may be something I can eliminate when I get through second year. I know a beta blocker would help reduce the tremors, but might make me tired. If there is nothing I can do about the tremors, should I just try to find another specialty?

 

[SSdoc33]

Right about the med but not for ADHD, for narcolepsy/idiopathic hypersomnia.
Unfortunately, there are not many other meds out there that I can use with success. I finally found a combination of medications that work really well for me so I can function like a normal human being for most of the day. However, it comes with the price of having tremors periodically throughout the day. Im sure the additional caffeine on top of the meds isnt helping and may be something I can eliminate when I get through second year. I know a beta blocker would help reduce the tremors, but might make me tired. If there is nothing I can do about the tremors, should I just try to find another specialty?

if you like the specialty, dont change your stance. its a very broad and diverse field, and there are lots of things you can do. if you have your heart set on injections only, then you may need to think about this pretty carefully

 

[Sartre79]

Right about the med but not for ADHD, for narcolepsy/idiopathic hypersomnia.
Unfortunately, there are not many other meds out there that I can use with success. I finally found a combination of medications that work really well for me so I can function like a normal human being for most of the day. However, it comes with the price of having tremors periodically throughout the day. Im sure the additional caffeine on top of the meds isnt helping and may be something I can eliminate when I get through second year. I know a beta blocker would help reduce the tremors, but might make me tired. If there is nothing I can do about the tremors, should I just try to find another specialty?

If you're having tremors you might be taking too much and could back off the dose(s) (of course work with your psychiatrist or sleep doc) to see if that helps. Have you tried Provigil? It's supposed to be a little friendlier than the psychostimulants, but as with most things is psych, mileage may vary.

 

[PMR 4 MSK]

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