Primary Care

Upper Extremity

Fractures: discussion includes common fracture management issues with mechanism, evaluation and treatment plan
Shoulder: discussion includes impingement syndrome, rotator cuff pathology, instability, labral tears, internal impingement, bicep pathology and periscapular contributors
Elbow: discussion includes little league elbow, UCL tears, ulnar nerve entrapment, medical epicondylitis and posterior impingement
Wrist/hand: discussions include tendonopathies, nerve impingement, avascular necrosis of bone, physeal injuries (gymnasts wrist), impingement syndromes, fractures and ligamentous instability.

Upper Extremity Neurologic Injuries

The following neuropathies will be reviewed for etiology, diagnostic considerations including imaging and EMGs as well as treatment options both conservative and surgical:

Thoracic outlet syndrome
Proximal neuropathies: Parsonage-Turner, spinal accessory, neuropathy
Long thoracic N, suprascapular N, axillary N, ulnar N, median N, radial N

Spine

Cervical: discussions include congenital abnormalities, growth considerations, fractures, acute neuropraxias, transient quadriparesis, disc pathology, facet syndrome, instability and myelopathy.

Thoracolumbar: Macro and micro trauma including adolescent and adult disc pathology as well as spondylolysis, apophysitis, scoliosis, kyphosis and lordosis.

Pelvis: discussions include labral and internal pathology, tendonopathies about the hip, sports hernia, femoral and inguinal hernias, osteitis pubis, local neuropathies, intrapelvic considerations, snapping hip, CAM and Pincer impingement, inflammation and infection. Pediatric considerations will include SCFE, AVN, infection and inflammation.

Sports Psychology

Emphasis on the recognition of psychologic stress in relation to sports injury and the need to address this in rehabilitation as well as utilizing psychologic evaluation and intervention in dealing with the athlete with disordered eating.

Chest and Abdominal Trauma in the Athlete

Knowledge of the evolution of internal injury in the athlete sustaining trauma to the chest and abdomen.

Lower Extremity

Fractures: pathology includes common fracture management, issues with mechanism, evaluation and treatment plan.

Knee: pathology includes cartilage loss, meniscal injury, varus/valgus instability, ACL (including female ACL issues, prevention, controversies in repair), patella-femoral issues (including compression syndrome, instability, plica, Hoffa fat pad, quadricep tendonosis, patella tendonosis), popliteal cyst, arthritis, tendonpathies about the knee. Pediatric considerations include discoid meniscus, ACL repair, fractures and physeal injuries.

Calf: stress fractures, MTSS, tendonitis, compartment syndrome.

Ankle: pathology includes fractures, instabilities, tendonopathies, anterior and posterior impingement and nerve impingement. Pediatric considerations include tarsal conditions, tethered cord, congenital abnormalities.

Foot: pathology includes fractures and instabilities, congenital abnormalities, stress fractures.

Neuropathies of the Lower Extremities

Adolescent Development: limb length, skeletal maturation, variants
On Field Management of the Athlete: airways, AED, spine board
Locker Room Medicine: suturing, RTP same game

Medicolegal Issues

Familiarity with medicolegal issues in sports medicine and prevention of these problems including maintaining good patient rapport and excellent record keeping.

Biostatistics

Attain a knowledge of basic biostatistics as well as the application to clinical research.

The primary care sports medicine fellows will attend the New England ACSM meeting, the annual ACSM meeting and the Team Physician Course by ACSM each year. The fellows will also attend the pulmonary sessions with Dr. Dawn Ericson.

Medical Issues

Concussions: understanding of the acute recognition and evaluation of concussion along with utilization of sideline assessment tools and IMPACT testing for more prolonged symptoms.

HEENT: the recognition of injuries about the face including laceration management, nasal and facial fractures, auricular hematomas, tooth avulsion and eye trauma.

PPE: proficiency in performing on site athletic preparticipation evaluations including musculoskeletal and medical evaluation with particular attention to cardiac evaluation.

Cardiac Issues: understanding the recognition and evaluation of athletes with cardiac symptoms and understand RTP criteria.

Exercise Physiology: understanding of the cardiopulmonary aspects of exercise physiology including V02 max, exercise testing, pulmonary function testing and the relationship to the exercise prescription as well as utilization in the athlete with medical problems.

Pulmonary Issues: athletes with asthma, restrictive airway disease will be understood with treatment and RTP criteria.

Hormonal Issues in Athlete:

Diabetes: understanding of the insulin and glucose requirements of the diabetic athlete as well as the evaluation of treatment options.
Disordered eating and bone health: understanding of the spectrum of the bulimic and anorexic athlete as well as understand the athlete with the caloric balance issues. Hormonal and bone health evaluation and treatment will be stressed. The multidisciplinary approach of medical, psychological and nutritional aspects will be addressed.

Infectious Disease in the Athlete: understanding of the implications of infection in the athlete including MRSA, mononucleosis, viral infections, skin infections such as herpes gladiatorum and Lyme disease.

Dermatological Issues in the Athlete: understanding of the recognition, evaluation and RTP criteria of dermatologic issues such as herpes gladiatorum, molluscum contagiosum, bacterial skin infections as well as inflammatory issues such as atopy and eczema.

Rheumatologic Issues in the Athlete: includes connective tissue disorders as they relate to cardiovascular considerations, inflammatory arthritis and spondyloarthropathy with respect of recognition of symptoms, laboratory evaluation and treatment options.

Steroids and ergogenic aids: understanding the positive and negative aspects of ergogenic aids as well as the legal evaluation and testing requirements by different sport governing organizations.

Hematologic Issues in the Athlete: understanding risks and prevention of thrombotic complications as well as the problems with inherited hematologic issues such as G6PD, sickle cell traits.

Nutrition
Knowledge of the essential micro and macronutrients, calorie counts and nutritional assessments.

Assessment and Measurement Tools

The primary care fellows will be given an interim examination every 4 months. This will cover the full spectrum of the curriculum. Furthermore, the fellows will be quizzed clinically while they are doing their nutritional and exercise physiology rotations which will be reflected on the evaluations for these rotations. As for the musculoskeletal exams, there will be mock sessions of clinical presentations that the primary care fellows will attend. Here they will be asked to evaluate a mock patient for history taking, examination technique and imaging evaluation. This will be reflected in their interim assessments.

The following is a general plan for presentation of the curriculum but is subject to change in respect to speaker availability and other confounding factors.

July: Since the new primary care sports medicine fellows will be starting and the orthopaedic surgery fellows do not start until August, the emphasis will be on fracture management and physical examination (this will also be repeated during the months addressing the specific body part)
August: Spine injuries as well as concussions, preparticipation examination and on field management of head and neck injuries. Biostatistics will also be initiated.
September: Knee injuries, nutritional evaluations, exercise physiology, infectious disease issues in the athlete, sports psychology.
October: Shoulder injuries, sports cardiology, rheumatology, dermatologic issues
November: Hand and wrist injuries, adolescent medicine, hematologic issues in sports medicine
December: Elbow injuries, chest/abdominal trauma, sports psychology, steroids and ergogenic aids
January: Calf and leg injuries, diabetes in sports, eating disorders
February: Ankle, pulmonary issues, TBA
March: Foot, TBA
April: HEENT, TBA
May: TBA
June: TBA

Division of Sports Medicine