Radiculopathies

[sprtsmeddoc]

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What's the prognosis?

 

[Bostonspine]

80% better in 3 months 90% at 1 year no matter what you do. From a stats perspective although you suffering may vary.

 

[sprtsmeddoc]

My attending told the patient they had to live with it, but the patient wants a cure. Didn't seem happy the attending said that. How do you word it to patients that have been dealing with it for some time?

 

[Taus]

Unless there is no nerve compression on mri or predominant axial pain, your attending is incorrect. If there is physical pressure on the nerve and predominant limb pain, surgical decompression is indicated and highly successful (if pain control/function not adequate after exhausting conservative treatment)

 

[j4pac]

My attending told the patient they had to live with it, but the patient wants a cure. Didn't seem happy the attending said that. How do you word it to patients that have been dealing with it for some time?

If that was the case many of us would be out of jobs! Lol. Good thing that’s inaccurate. PM&R prides itself in having tools to treat challenging conditions. It’s uncommon to have nothing but “live with it” as a treatment option.

 

[sprtsmeddoc]

Ok! I’m interested in PMR. Do you have guidance on a good resource for a student to read to get started?

 

[sloh]

Ok! I’m interested in PMR. Do you have guidance on a good resource for a student to read to get started?

UpToDate is a good resource for this

 

[fozzy40]

Would check this out.

 

[RangerBob]

 

[Splenda88]

View attachment 282705

That is hilarious!

I'm an IM PGY2... and not sure when I should consult PM&R. Sometimes we get pain on board but they are always Gas/Pain... For patients with physical deconditioning (which we deal with everyday), we always get PT/OT on board. When is it appropriate to get physiatry on board?

 

[runfastnow]

That is hilarious!

I'm an IM PGY2... and not sure when I should consult PM&R. Sometimes we get pain on board but they are always Gas/Pain... For patients with physical deconditioning (which we deal with everyday), we always get PT/OT on board. When is it appropriate to get physiatry on board?

Inpatient physiatry/PM&R consults can be quite varied.

Some training programs/health systems PM&R consults are 90+% for post-discharge placement (acute rehab vs SNF vs LTACH, etc.).

Other places utilize PM&R much more robustly for things like (off the top of my head):
- Amputee medicine (pre- and post-amputation) along with appropriate post-discharge rehab facility placement for training and long-term management
- Traumatic brain injury in trauma ICU/NICU/"regular" ICU settings (including disorders of consciousness)
- Spinal cord injury in trauma/ICU or non-ICU settings
- Spasticity management (Botox, oral meds, intrathecal baclofen pumps, etc.)
- Pain management (depending on your health system)
- Inpatient EMGs both diagnostic and intraoperatively (depending on health system)

I'm sure there are a few other things I'm missing, but those are probably the major categories

 

[fozzy40]

Agree with @runfastnow. Pretty much anytime you question someone's ability to return home safely and without assistance you should think about PT and potentially a PM&R consult. Categorically acute or recurrent neurologic injuries and cardiopulmonary patients are common reasons from an adult standpoint.

 

[Baron S]

80% better in 3 months 90% at 1 year no matter what you do. From a stats perspective although you suffering may vary.

The cause of the radiculopathy and nature of the disc derangement matters, too.

The probability of spontaneous regression of lumbar herniated disc: a systematic review - PubMed

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc...

www.ncbi.nlm.nih.gov

In general, the more "acute" an injury, the higher likelihood of spontaneous resolution. An ugly disc protrusion is much more likely to improve than a disc-osteophyte complex with concurrent facet hypertrophy causing bony foramen stenosis.

I counsel patients that nothing I do improves your underlying pathology. My goal is to help you function and not be miserable while your body(hopefully) repairs itself.

 

[thiswonthurtabit]

I counsel patients that nothing I do improves your underlying pathology. My goal is to help you function and not be miserable while your body(hopefully) repairs itself.

I use a line with a very similar flavor with most of my patients 🙂.