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Orthopedics Rotation

Page history last edited by rchamberlain@salud.unm.edu 1 month, 2 weeks ago

UNM FAMILY MEDICINE RESIDENCY

ROTATION INFORMATION

ORTHOPEDICS

 

Rotation Contact and Key Personnel:

Rotation Contact:  Rachel Chamberlain - RChamberlain@salud.unm.edu 

Rotation Contact for Carrie Tingley Peds Ortho Judith McMullan 272-5214JMcMullan@salud.unm.edu

Orthopedics Attending and Program Director: Selina Silva MD, Orthopedics Dept, SSilva@salud.unm.edu 

 

PLEASE ALSO  CHECK POWERCHART TO CONFIRM THAT PROVIDERS HAVE PATIENTS SCHEDULED FOR THE DAYS YOU ARE SUPPOSED TO WORK WITH THEM.

CONTACT DR. CHAMBERLAIN IF THEY DON'T HAVE PATIENTS SCHEDULED TO GET ALTERNATE OPTIONS. TIGER OR 919-906-2421. 

 

Rotation Duration: 4 weeks (will often be split into two 2 week blocks)

Supervision: Ortho Faculty at each clinic site; Senior Ortho resident on call

Introduction: Musculoskeletal complaints rank second only to upper respiratory infections as the reason for seeking medical attention  (Woodell 2004).  This rotation is designed to educate you on the diagnosis and treatment of common musculoskeletal conditions.  Resources for musculoskeletal evaluation and treatment are provided on this page under 'Web-based resources for reading', below.  They are web-based and easy to navigate.  One is produced by UCSD SOM and is mainly about the MS exam with photos, explanations and videos.  The other is an AAFP site utilizing AFP articles.  It is extensive and references material that the ABFM tends to test you on in the boards.  Key to maximizing this training is knowledge of normal anatomy, musculoskeletal history taking and differential diagnosis of complaints by anatomical location.  By using the resource websites provided, you may choose learning issues in an a la carte manner prior to the different ortho clinics that will profoundly enhance your learning experience.  It is strongly recommended that you prepare in this manner and attend all clinics.   

 

Section 2: Schedule For Orthopedics 

FM Resident Ortho Rotation - Listed in QGenda on which rotation schedule you will follow as Orthopedics 1 or Orthopedics 2

 

Rotation Orthopedics Schedule 1

 

Monday

Tuesday

Wednesday

Thursday

Friday

Weekend

AM

CHILE with Dr. Eric Lew

Location: 

CHILE Clinic

4th Floor UNMH 

next to 

Pre Anesthesia Clinic

(arrive 7:30 for 8am clinic start)

Dr. Rick Gehlert Orthopedic Hip Clinic (1 ACC General Ortho Clinic)

Dr. Emily Olson UNM Athletics Training room

Continuity Clinic

General Ortho Clinic (1ACC) Dr. Rick Miller Foot and Ankle

OR

CTH Peds Ortho Hand Clinic- Dr. Deana Mercer

 

PM

Continuity clinic

CTH Peds Clinic

Dr. Selina Silva (Please email SSilva@salud.unm.edu prior to the start of the rotation)

Location: 

Carrie Tingley Hospital

Residency School

Continuity Clinic

Continuity Clinic

 

 

Rotation Orthopedics Schedule 2

 

Monday

Tuesday

Wednesday

Thursday

Friday

Weekend

AM

FIRST MONDAY ONLY

SRMC/COE Joints - Victoria Freeman, PA

3200 Broadmoor blvd NE, Rio rancho 87144;  Pod #5

 

ALL OTHER MONDAYS- SRMC Dr. Gwen (Nicky) Lacerda- Spine

Dr. Rebecca Dutton UNM Athletics Training Room

SRMC/COE Clinic- Dr. Meghan Whitmarsh Brown (Joints)- Pod #5

OR

Admin/Self study/Project time 

SRMC/COE Clinic- Dr. Meghan Whitmarsh Brown (Joints)- Pod #5

Continuity Clinic

 

PM

SRMC/COE Joints Clinic-  Victoria Freeman, PA

3200 Broadmoor blvd NE, Rio rancho 87144  Pod #5

Continuity Clinic

Residency School

SRMC/COE Clinic- Dr. Meghan Whitmarsh Brown (Joints)- Pod #5 

Continuity Clinic

 

 

 

Pre-requisites:

Before working with Dr. Lew at the CHILE clinic, consider reviewing these key articles (which can be accessed through the google drive shared folder): https://drive.google.com/open?id=0B6kh1Ug2jMUAMEdXRDR6aTRIRVU 

Three articles to focus on:
·       Mills JL, et al. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: Risk stratification based on Wound, Ischemia, and foot Infection (WifI).  J Vasc Surg 2013; 1 -15

 ·       Boulton AJM, et al.  Comprehensive Foot Examination and Risk Assessment, Diabetes Care, 2008, Vol 31, 8
·       Miller JD, Carter E, Shih J, Giovinco NA, Boulton AJ, Mills JL, Armstrong DG. How to do a 3-minute diabetic foot exam. J Fam Pract. 2014 Nov; 63(11):  646-56

 

While working with Dr. Lew, discuss and review the problem based learning cases:  Problem Based Learning_CHILE_Topics.pdf

 

Before working in the Sports Medicine clinics, review the shoulder and knee exam:  Shoulder examination.pdf ,   Knee examination.pdf

      That's the knee! http://www.fammed.wisc.edu/our-department/media/623/knee-exam

      Shoulder exam! http://www.fammed.wisc.edu/our-department/media/623/shoulder-exam

      For additional articles and videos: http://www.fammed.wisc.edu/our-department/media

 

Web-based resources for reading: 

http://meded.ucsd.edu/clinicalmed/joints6.htm  

http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=17

http://bonetumor.org/

http://www.orthobullets.com/default

 

Viscosupplementation for the Treatment of Osteo of the Knee Review.pdf

Osteoarthritis Guide.pdf

 

Recommended reading: "Fracture Management for Primary Care"

 

Resources from Dr. Lacerda:

Wessberg, P., Frennered, K. Central lumbar spinal stenosis: natural history of non-surgical patients. Eur Spine J 26, 2536–2542 (2017). https://doi.org/10.1007/s00586-017-5075-x

McCormick JR, Sama AJ, Schiller NC, Butler AJ, Donnally CJ 3rd. Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management. J Am Board Fam Med. 2020 Mar-Apr;33(2):303-313. doi: 10.3122/jabfm.2020.02.190195. PMID: 32179614.

Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009 Dec 15;147(1-3):17-9. doi: 10.1016/j.pain.2009.08.020. Epub 2009 Sep 16. PMID: 19762151.

Bogduk N. Management of chronic low back pain. Med J Aust. 2004 Jan 19;180(2):79-83. PMID: 14723591.

Furman MB, Johnson SC. Induced lumbosacral radicular symptom referral patterns: a descriptive study. Spine J. 2019 Jan;19(1):163-170. doi: 10.1016/j.spinee.2018.05.029. Epub 2018 May 22. PMID: 29800710.

Stout, A., Friedly, J. and Standaert, C.J. (2019), Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. PM&R: The Journal of Injury, Function and Rehabilitation, 11: 409-419. https://doi.org/10.1002/pmrj.12042

Bogduk N. The anatomy and pathophysiology of neck pain. Phys Med Rehabil Clin N Am. 2011 Aug;22(3):367-82, vii. doi: 10.1016/j.pmr.2011.03.008. PMID: 21824580.

Bogduk N. The Neck and Headaches. Neurologic Clinics, 2014-05-01, Volume 32, Issue 2, Pages 471-487, Copyright © 2014 Elsevier Inc.

Fish DE, Gerstman BA, Lin V. Evaluation of the patient with neck versus shoulder pain. Phys Med Rehabil Clin N Am. 2011 Aug;22(3):395-410, vii. doi: 10.1016/j.pmr.2011.03.009. Epub 2011 May 31. PMID: 21824582.

Schneider BJ, Rosati R, Zheng P, McCormick ZL. Challenges in Diagnosing Sacroiliac Joint Pain: A Narrative Review. PM R. 2019 Aug;11 Suppl 1:S40-S45. doi: 10.1002/pmrj.12175. Epub 2019 Jul 3. PMID: 31020770.

Stout, A., Friedly, J. and Standaert, C.J. (2019), Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. PM&R: The Journal of Injury, Function and Rehabilitation, 11: 409-419. https://doi.org/10.1002/pmrj.12042

Bogduk- PDF on The Anatomy and Pathophysiology of Neck Pain Bogduk_The Anatomy and Pathophysiology of Neck Pain - 1-s2.0-S1047965111000386.pdf

 

Casting videos from Dr. Silva:

Long arm splint.mp4

Thumb Spica Splint.mov

Long Leg Posterior Splint.mp4

Short Arm Splint.mp4

Short Leg Splint.mp4

  

Section 3: Goals and Learning Objectives

 

During this rotation the resident will recognize, assimilate, and increase their skill in  those aspects of orthopedic problems/diseases that are necessary for daily patient care.  At the conclusion of this training, the resident will have increased knowledge and skill to manage the majority of the orthopedic problems that are commonly seen by Family Practitioners and also recognize the need for proper referral and consultation by a specialist for those that are beyond their capabilities.

 

Patient Care Objectives:  The resident will

  1. be able to do a detailed orthopedic examination of the spine, shoulder, hip, knee, ankle, wrist and  hand.
  2. properly perform joint injections and aspiration with sterile technique, focus on shoulder and knee
  3. describe the work up for a patient with extremity pain with the orthopedic preceptor and develop the differential diagnoses and treatments 
  4. observe, discuss, and learn the proper application of an appropriate brace, splint, or cast 

 

         

As always, please see the competency based goals and objectives

 

 

 

 

 

 

 

 

 

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