The Medical Student's Guide to PM&R
Especially in the inpatient setting, physiatrists provide general medical treatment similar to internal medicine to maintain medical stability and provide secondary prevention of disability. Physiatrists do not perform surgery yet have many procedural opportunities for diagnosis and treatment. Many of these procedures may require fellowship or advanced training to perform. These procedures include:
- EMG (electromyography): inserting fine needle electrodes in muscles and observing the recorded motor unit potentials when the muscles are activated to help distinguish whether weakness is due to muscle or nerve dysfunction (i.e., myopathy vs. neuropathy).
- NCS (nerve conduction studies): use of electrodes to record motor and sensory responses that are propagated by electrical stimuli. This test can help distinguish location of a nervous system lesion (radiculopathy, peripheral neuropathy, motor neuron disease, or neuromuscular junction).
- Peripheral joint injections: injections to help diagnose and treat bone and soft tissue disorders often seen in orthopedic, rheumatologic, and sports medicine disorders such as knee osteoarthritis, rotator cuff tendinopathy, and epicondylitis.
- Trigger point injections: lidocaine or dry needling can be used as an adjunct to proper exercise and physical therapy to treat trigger points, thought to be sources of chronic myofascial (soft-tissue) pain.
- Musculoskeletal ultrasound: although it has been used for decades as a modality to deliver deep heat in therapies, ultrasound is now increasingly being used in the outpatient setting to supplement the musculoskeletal evaluation through visualization of the structures. Ultrasound may be used to evaluate for soft tissue abnormalities in commonly examined joints and structures. This technology is also now frequently used to guide injections, as it allows for improved placement of needles for delivery of treatment without exposure to ionizing radiation.
- Spasticity management: spasticity is a common complication related to CNS injury (e.g., SCI, stroke, cerebral palsy). Physiatrists treat spasticity by using oral antispasticity agents, botulinum toxin injections, phenol injections, and intrathecal baclofen pump management to improve function and decrease pain.
- Interventional spinal therapeutics: image-guided spinal diagnostics and injections, including discograms, interlaminar and transforaminal epidurals, and radiofrequency ablations, spinal cord stimulation, vertebroplasty/kyphoplasty, and intrathecal pump placements. These techniques are being used as a nonsurgical pain-relieving intervention for back pain and radiculopathy.
- Other procedures performed by some physiatrists include acupuncture, prolotherapy, platelet rich plasma injections, and autologous stem cell treatments.