Sports Medicine

Description:
Residents will observe and participate in the care of the sports medicine patient.  The resident will rotate as a PGY-2 and PGY-4.

Resident role and expectations:
As a primary function, the role of the resident will be to perform major and minor operations in the capacity of primary or assistant surgeon.  The resident and fellow will also participate in initial evaluation, peri-operative care, and non-operative treatment of orthopaedic injuries and diseases, including those of the Knee, Shoulder, Elbow and Hip, in addition to general orthopaedics and sports medicine.  There will be increased clinical and operative responsibilities during the PGY-4 year after completion of the PGY-2 rotation as follows:

PGY-2
By the end of the sports rotation, the junior resident should be competent in performing a complete and thorough examination of the shoulder, elbow, hip and knee.  The resident should learn the skills to examine an athlete both on and off the field.  Skills need to be developed to obtain history and physical examination with the injured athlete.  The resident should also be competent in identifying various sports pathology and initiating the appropriate work-up.

The resident should be aware of the natural history and recommend treatment for common overuse syndrome, ligament deficiencies and fractures.  They should be comfortable in diagnosing common sports injuries such as ACL ruptures, meniscal tear, rotator cuff rupture, impingement syndrome and elbow ligament injuries.  They should be familiar with various work-up for such pathology, such as injections, provocative tests, classic symptoms and magnetic resonance imaging.  With this rotation, the resident should be competent in interpreting various specific radiographic views for specific pathology, e.g. Rosenberg View for mild knee DJD and Axillary view to look for Os Acromiale, etc…  Since a lot of diagnoses are also made with the assistance of MRI, residents should be comfortable in interpreting MRI of the shoulder and knee.

The resident should concentrate on the development of surgical skills in the various exposures for the shoulder, elbow, hip and knee.  During this rotation, they should develop competency in arthroscopy.  This rotation should provide ample opportunity to improve their arthroscopy technique.  Junior residents should be able to perform simple diagnostic arthroscopy of the knee and shoulder before the end of the rotation.  If working with Dr. Looney, they should also be able to perform simple diagnostic hip arthroscopy.  Besides mastering simple surgical procedures, the resident should understand the possible complications of these operations and be able to identify signs and symptoms of patients with complications following these operations.

PGY-4
For the senior resident, the rotation should focus on developing proficiencies on the diagnostic and treatment of various sports medicine ailments.  They should be able to tackle more complicated diagnosis such as shoulder instability, multi-ligament injured knees, etc…

The resident should be competent in surgical skills involving arthroscopy of various joint.  They should also be more proficient in performing higher level surgical procedures, such as arthroscopic acromioplasty, distal clavicle resection, arthroscopic lateral releases and ACL reconstruction.  Diagnostic elbow arthroscopy is also a surgical procedure that should be mastered by the senior resident. If working with Dr. Looney, they should also be able to perform hip arthroscopy.

The senior resident should provide guidance to the junior resident during the rotation to develop their skills in achieving the above objectives.  The senior resident should assist the junior residents in making diagnoses and interpreting radiographic finding.

Readings:

  • Manual of Sports Medicine – Safran, McKeag, Van Camp
  • Orthopaedic Knowledge Update – Sports Medicine 2
  • Orthopaedic Knowledge Update – Shoulder and Elbow
  • Orthopaedic Knowledge Update 6
  • Knee Surgery – Fu, Harner
  • Review of Sports Medicine and Arthroscopy – Miller
  • he Hughston Clinic – Sports Medicine Book – Baker
  • Surgical Exposures in Orthopaedics – Hoppenfeld

Attendings:
John E. Kuhn, M.D.
Charlie Cox, M.D.
Jaron Sullivan, M.D.

Goals and objectives by the end of the rotation:

  1. Medical knowledge:  Topics to be covered during this rotation:
    • Biomechanics of ligaments
    • Shoulder, Elbow and knee biomechanics
    • Common elbow pathology, including ligament insufficiency, overuse syndrome
    • Knee ligament reconstruction, ACL MCL, PCL, PLC and multi-ligament injured knees
    • Meniscal pathology
    • Osteochondral defect
    • Patellofemoral disorders and treatment
    • Stress fractures
    • Overuse syndrome and various tendonitis
    • Rotator cuff pathology
    • Acromioclavicular joint pathology
    • Impingement syndrome
    • Shoulder Stiffness
    • Shoulder instability and treatment
    • Management of athletes both on and off the field
    • Sports injuries in the pediatric population
    • Femoroacetabular Impingement
    • Hip Labral Tears
    • Hip biomechanics
    • Elbow Injuries
    • Epicondylitis
    • Ligament injuries of the elbow – ulnar collateral and lateral ulnar collateral ligaments
  2. Patient care:  The resident will attain the surgical skills necessary for triangulation in shoulder and knee arthroscopy.  The resident should be competent in basic shoulder and knee arthroscopic procedures by the end of the rotation.  The resident will also be exposed to wrist, elbow, and hip arthroscopy during the rotation.
  3. Practice-based learning:  The resident will demonstrate competence in the ability to evaluate their own performance and utilize attending feed-back to improve their performance, both in clinic/OR and the surgical skills lab.
  4. System-based practice:  The resident will appropriately delegate resource management and use of outside services such as physical therapy, MRI and interventional radiology, and team trainers.  The resident will also become familiar with return to play guidelines and on- field treatment considerations for the athlete.
  5. Professionalism: Demonstrate initiative in the needs of patients and professional staff, showing honesty, compassion, and respect for the patient issues both in terms of the medical diagnosis and the psychosocial ramifications.
  6. Practice-based learning:  Demonstrate self-improvement through a critique of their performance during presentation of M & M cases.