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 272-5214: JMcMullan@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
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Weekend
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AM
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CHILE with Dr. Eric Lew
Location:
CHILE Clinic
4th Floor UNMH
next to
Pre Anesthesia Clinic
(arrive 7:30 for 8am clinic start)
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Dr. Rick Gehlert Orthopedic Hip Clinic (1 ACC General Ortho Clinic)
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Dr. Emily Olson UNM Athletics Training room
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Continuity Clinic
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General Ortho Clinic (1ACC) Dr. Rick Miller Foot and Ankle
OR
CTH Peds Ortho Hand Clinic- Dr. Deana Mercer
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PM
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Continuity clinic
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CTH Peds Clinic
Dr. Selina Silva (Please email SSilva@salud.unm.edu prior to the start of the rotation)
Location:
Carrie Tingley Hospital
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Residency School
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Continuity Clinic
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Continuity Clinic
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Rotation Orthopedics Schedule 2
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Monday
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Tuesday
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Wednesday
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Thursday
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Friday
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Weekend
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AM
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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
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Dr. Rebecca Dutton UNM Athletics Training Room
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SRMC/COE Clinic- Dr. Meghan Whitmarsh Brown (Joints)- Pod #5
OR
Admin/Self study/Project time
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SRMC/COE Clinic- Dr. Meghan Whitmarsh Brown (Joints)- Pod #5
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Continuity Clinic
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PM
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SRMC/COE Joints Clinic- Victoria Freeman, PA
3200 Broadmoor blvd NE, Rio rancho 87144 Pod #5
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Continuity Clinic
|
Residency School
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SRMC/COE Clinic- Dr. Meghan Whitmarsh Brown (Joints)- Pod #5
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Continuity Clinic
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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
- be able to do a detailed orthopedic examination of the spine, shoulder, hip, knee, ankle, wrist and hand.
- properly perform joint injections and aspiration with sterile technique, focus on shoulder and knee
- describe the work up for a patient with extremity pain with the orthopedic preceptor and develop the differential diagnoses and treatments
- 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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