Whether you’re an athlete or someone who simply wants to reduce their pain, understanding how a musculoskeletal health doctor can help you manage your discomfort is key to reaching your goals. It is especially important to do your research on the right musculoskeletal physician, because not all physicians or practices are created equal.
Our physicians at APEX Orthopedics & Sports Medicine use our private-practice model to provide the best care for each of our patients. We’ve recently welcomed Dr. Moore to our practice to further extend our capabilities. Her passion for musculoskeletal health pushes her to ensure each patient feels valued, comfortable, and at ease knowing they are getting top-of-the-line diagnosis and treatments.
Read on to learn more about what to expect when you visit a musculoskeletal health doctor in Kansas City.
What is a musculoskeletal health doctor?
The technical term for a doctor who focuses on muscle and joint health is a Physical Medicine & Rehabilitation (PM&R) physician. Specifically, a PM&R physician provides diagnoses and management for conditions affecting the joints, muscles, ligaments, tendons, nerves, and other physical structures. These conditions include:
- Carpal tunnel syndrome
- Sports-related injuries
- Tendinopathy & fasciopathy
- and more
PM&R physicians are well versed in comprehensive conservative non-operative management options. You can think of them as the non-operative counterpart to orthopedic surgeons, where orthopedic surgeons are experts in surgical management for musculoskeletal conditions while PM&R physicians are experts in conservative treatment options. The main goal is to create outcomes that maximize patients’ functionality so they can return to their regular activities.
Since PM&R physicians are specialized doctors, after completing medical school they must go through a four year residency in Physical Medicine & Rehabilitation. In many cases, these physicians will go through further subspecialty fellowship training or certification, which may include areas such as:
- Sports Medicine
- Pain Medicine
- Brain Injury Medicine
- Spinal Cord Injury Medicine
- Pediatric Rehabilitation Medicine
- And more
Common procedures and treatments to expect from a musculoskeletal doctor
When you visit a PM&R physician, you can expect to go through a detailed evaluation of your complaint and corresponding physical examination. Sometimes other tests are needed to determine the correct diagnosis. This may include X-rays, ultrasound, MRI, or electrodiagnostic testing.
PM&R physicians try to optimize conservative non-operative measures when approaching injuries and diagnoses. Surgical referral or management options may be part of the end discussion, but for a majority of musculoskeletal complaints, surgery is not the first or best choice. A few examples of conservative musculoskeletal treatments include:
- Physical therapy tailored to your diagnosis
- Modifications in your activities
- Braces or orthotics
- Medications such as neuropathic and other pain medication
- Steroid injections
- Viscosupplementation injections
- Orthobiologic injections (such as platelet-rich plasma or bone marrow aspirate concentrate)
- Ultrasound guided minimally invasive tendon procedures
- Shockwave therapy
At the end of the day, physicians will align their management recommendations with your goals. Therefore, two people with the same diagnosis may undergo two different management plans. For example, someone who is a competitive athlete may need more intensive management to get them back to full play, whereas someone who wants to be more functional and less painful with daily walking may be able to have successful outcomes with less intensive management. .
Here are a few common procedures and treatments Dr. Moore utilizes in her practice at APEX.
Dr. Moore uses ultrasound to help guide procedures for both basic injections as well as higher level procedures. Ultrasound allows you to visualize the intended target (whether that be a joint, tendon, fascia, or nerve) in real time and guide the needle directly to that target to ensure accurate placement of the injection while also limiting unintended injury to nearby nerves, blood vessels, or other structures.
At APEX, ultrasound technology allows Dr. Moore to better be able to maximize accuracy for the best possible outcomes.
Learn the basics on how an ultrasound works.
As a result, during a procedure, Dr. Moore receives instantaneous feedback through dynamic viewing to get a much better and closer understanding of the injection site. This effectively reduces the (already small) chance of human error while injecting the area.
To determine who is a good candidate for ultrasound-guided injections, Dr. Moore looks at the “who, what, and where.”
The “who”—meaning you as a patient—requires expert attention to detail when it comes to your past medical history, specific circumstances, goals, and current condition. Considering all of these nuances and discussing expectations of the injection before it is performed helps optimize your specific outcome.
Next comes the “what.” What kind of injections are out there and which one will work best for you? Dr. Moore is adept at incorporating evidence-based research and personal experience with your particular circumstances when discussing and comparing various injectate options.
From there, Dr. Moore looks at the “where,” which to her means using ultrasound guidance to optimize the accuracy of the injection while reducing the risk of an injection.
Nerve pathology evaluation and management
Nerve injuries require unique approaches compared to other musculoskeletal conditions to fully assess the presence and extent of injury. Two common, and often complementary, ways to evaluate nerves are with electrodiagnostic studies and ultrasound.
Electrodiagnostic studies help measure the function of the nerves and consist of two portions:
- Nerve conduction study (NCS): sending small shocks down a nerve to assess its ability to carry information
- Electromyogram (EMG): placing small pins or needles into the muscles to evaluate the ability of nerves to appropriately signal to the muscle
You can think of nerves as electrical wires, and muscles as light bulbs connected to those wires. The NCS tells us if that portion of “wire” is intact and carrying messages with the appropriate speed & strength. This is completed by sending small shocks along a nerve and measuring the response up or downstream and comparing those values to normal values. The EMG portion tells us if that “wire” is doing its appropriate end function of turning the “light bulb” on. This is completed by inserting small pins (or acupuncture-sized needles) into the muscle and listening to their electrical responses at rest and with activity. The pins do not carry any shocks or electricity themselves, they just listen to and pick up the electrical sounds in the muscle.
Dr. Moore then interprets the findings of the NCS with the EMG (along with the clinical history and physical examination) to come up with the impression of the study. Depending on the pattern of findings conditions like carpal tunnel syndrome (median neuropathy at the wrist), “pinched” nerves in the spine (radiculopathy), and peripheral neuropathies, among other conditions, can be diagnosed. Electrodiagnostic studies can be helpful by confirming suspected diagnoses, excluding other disease processes, and defining the severity of nerve injuries to help guide management decisions and discussions on prognosis.
If you have not had an electrodiagnostic evaluation before, you may not know what to expect during the appointment. Patients generally tolerate both the NCS and EMG portions well, though there may be some discomfort at times. Dr. Moore will be right beside you throughout the examination, and you may take breaks as needed. If you cannot tolerate the exam, she will stop immediately. Electrodiagnostic studies are quite safe, and other than mild discomfort at the time of the procedure and minor bruising after the needle exam, they rarely are associated with other side effects.
There are no frank contraindications to NCS or EMG. They can be performed in people with implanted electrical devices like cardiac pacemakers, defibrillators, and spinal cord stimulators. However, we avoid any needle exam over damaged skin (scars, ulcers, rashes, infection) and swollen edematous limbs. If you are on anticoagulants or have known low platelets (thrombocytopenia), specific considerations may be taken during the needle portion to further reduce the minimal procedural risks. Standard infectious/sterile precautions are used, including disposable electrodes, use of gloves, and cleansing the skin with alcohol before the needle exam. The examinations can take anywhere from 30 to 60+ minutes. It is helpful if you wear loose or layered clothing so that it is easy for Dr. Moore to access different body regions.
While electrodiagnostic studies evaluate the function of nerves, Dr. Moore is also well versed in using ultrasound imaging to evaluate the structure of nerves. Ultrasound can help localize sites of compression, entrapment, or other injury. Having information on the nerve structure can be helpful in guiding management options and discussions on prognosis. Certain nerve conditions can even be managed with ultrasound guided procedures, such as using ultrasound guided steroid injections for carpal tunnel syndrome.
Understanding the nerve injury and the extent of the injury leads to discovering which treatment options will best suit the patient. As always, each treatment is fully individualized to each person and their goals.
Sports-related injuries and treatment
A PM&R physician, such as Dr. Moore who specializes in sports medicine, treats a variety of musculoskeletal conditions that can affect athletes of all ages and expertise.
Keep in mind that these conditions aren’t exclusive to athletes, and regardless of your activity level you may benefit from the help of a Sports Medicine PM&R physician. Common conditions treated include, but aren’t limited to:
- Ligament sprains or tears
- Tendon tears
- Muscle strains
- Knee injuries
- Rotator cuff injuries
- Spinal injuries
- Concussion-related brain injuries
For athletes, often their number one goal is to return to play as quickly as possible. Dr. Moore is well versed in considering this when discussing management options.
Certain conditions, like concussions, require strict management and return to play guidelines to optimize athlete safety and health. A concussion is a mild traumatic brain injury caused by a direct blow to the head or acceleration forces on the head. Concussions don’t cause frank structural damage, but rather the injury causes a temporary dysfunction in how the brain functions from a neurochemical stand point.
There is no single test that can diagnose a concussion, but rather it is diagnosed when someone has a potential injury mechanism (like a blow to the head) and develops specific signs (temporary loss of consciousness) or symptoms (headache, dizziness, etc.) immediately thereafter. Symptoms from a concussion generally improve/resolve over days to weeks.
Concussions are managed with a gradual return to activities (school/work and sport). Sometimes specific therapy is recommended to optimize recovery. Occasionally certain supplements or medications may be recommended to improve symptoms as your brain heals. If someone sustains a second concussive blow while their brain is still healing from a previous concussion, there can be significant complications including potentially long-term or life-threatening damage. It is important not to return to full sport until you are asymptomatic, tolerating all cognitive school/work activities, and have tolerated a gradual return back to play.
Other musculoskeletal conditions may allow for more wiggle room in considering individual circumstances and return to play goals. For instance, patellar tendonitis/tendinopathy refractory to typical physical therapy can be managed with a variety of options. For an in-season athlete, an ultrasound-guided “tendon scraping” procedure can quickly improve pain and allow the athlete to safely finish a season. For an athlete in the off-season who has more time to commit to rest and recovery, other tendon procedures may provide better long term outcomes.
Get to know Dr. Moore at APEX Orthopedics & Sports Medicine
Dr. Moore is our newest addition to the APEX team and one of the only two sports-fellowship trained PM&R physicians in the Kansas City area. With subspecialties in sports medicine and musculoskeletal ultrasound, Dr. Moore has the credentials and tools to treat most musculoskeletal injuries from acute injuries to chronic overuse injuries.
Her time at Mayo Clinic has ingrained in her the importance of using an evidence-based approach while remaining ahead of cutting-edge medical advancements. In her practice, she utilizes therapeutic and diagnostic ultrasound-guided injections, regenerative and orthobiologic treatments, and advanced minimally invasive tendon procedures such as Tenex.
The core of patient success lies in proper diagnosis. An appointment with Dr. Moore includes the highest quality technology to pinpoint your underlying musculoskeletal conditions. From there, she can better understand which treatment option would be the best solution.
For a thorough evaluation with Dr. Moore, call us at 913-642-0200 or schedule an appointment today.