Musculoskeletal Medicine

[interjectionreflection]

Apologies in advance for naive questions. But I have been asked to provide some services and want to get some advice before considering.
Any good sources to learn more about MSK? online or textbooks. I am not PMR trained but would like to learn. I don't expect to be as good as PMR or sports but would like to be able to manage MSK issues as there is a need in my community (PMR retired). I have been managing degenerative joints so feel comfortable with that. I am more interested in soft tissue structures (ligaments, tendons, bursitis etc.).
Would like to learn when its necessary to refer to a surgeon (outside the obvious -- acute tear with retraction, instability etc.) and doing injections, bracing activity modifications.
In fellowship I saw some of this when working with PMR staff and my basic understanding was rest, NSAIDs, PT, injection --> surgery if all fails and patient wants it. But of course I did not see every single type of ligamentous injury in that time frame. I did get a decent volume of injections for various injuries.
Did anyone get more experience with this in their fellowships? As pain docs are we supposed to know the types of bracing for certain issues or specific exercises or activity mods for MSK issues?
Is there a high degree of liability in this? My assumption is that for these chronic issues its less so? Anything to be aware of?

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[callmeanesthesia]

Same. I’d especially love if there’s a nice big CME video lecture series I could do that would cover all the basics.

 

[Ducttape]

so they want you to take on a role as a PMR or a sports med doc?

do you have a sports med, ortho or PMR doc in the system you work with, because it seems like this would be a great collaboration for you to work with them on these patients.

 

[interjectionreflection]

so they want you to take on a role as a PMR or a sports med doc?

do you have a sports med, ortho or PMR doc in the system you work with, because it seems like this would be a great collaboration for you to work with them on these patients.

Kind of, They have asked to see the MSK patients from the PMR that is retiring. As far as I can tell no one else for at least 2 hour drive to see them. They had almost exclusive sports and MSK practice. Lots of regenerative as well.

 

[kstarm]

Hmmm...I guess I would want to know expectations pretty clearly. It is a completely different specialty with evolving treatments, diagnostic work-ups etc. Are you better than no one, sure, but I think you should be really clear on scope and what you are comfortable with. Concussion, return to play/work issues, surgical referral, biologics, etc. I wouldn't just start practicing neurology even though I know enough to get in trouble. Will your mal-practice cover you if you start practicing outside of your specialty? I definitely like the idea of shadowing with someone along with all the CME you are thinking of doing.

 

[interjectionreflection]

From what I understand it's all MSK. Mainly chronic. No headaches, concussion etc. Mainly doing the non-operative stuff for ligament injury, tendinopathies, bursitis and OA. No expectation of biologics. They would like me to take over injection from last doc (PRP/HA/CS). I want to learn some of the other stuff though. I don't think I'm expected to give physical therapy exercises specifically beyond recommending to see a physiotherapist or bracing specialist. No general PMR like stroke/arthroplasty rehab though

 

[Ducttape]

2 hours? wow.

i would think taking over injection therapy would be the easy piece and the piece that would be most beneficial to your practice. apparently, there are lots of PRP courses, or maybe drusso can set you up with a good one.

do you have a good PT that you work with locally?