Treatments and Procedures Physiatrists Perform


Especially in the inpatient setting, physiatrists provide general medical treatment like internal medicine to maintain medical stability and provide secondary prevention of disability. Physiatrists do not do operation yet have many procedural opportunities for diagnosis and treatment. Many of these procedures may require fellowship or innovative training to perform. These PM&R treatment procedures include:

EMG (electromyography): Introducing fine needle electrodes in muscles and observing the noted motor unit potentials when the muscles are activated to help distinguish whether weakness is due to muscle or nerve dysfunction (i.e., myopathy vs. neuropathy).

NCS (nerve conduction studies): Usage of electrodes to record motor and sensory responses that are propagated by electrical stimuli. This treatment can help distinguish the location of a nervous system lesion (radiculopathy, peripheral neuropathy, motor neuron disease, or neuromuscular junction).

Peripheral joint injections: Injections to help identify and treat bone and soft tissue disorders frequently seen in orthopedic, rheumatologic, and sports medicine disorders such as knee osteoarthritis, rotator cuff tendinopathy, and epicondylitis.

Trigger point injections: lidocaine or dry needling can be used as an adjunct to proper exercise and physical therapy to treat trigger points, thought to be bases of chronic myofascial (soft-tissue) pain.

Musculoskeletal ultrasound: Although it has been used for years as a modality to deliver deep heat in therapies, ultrasound is now progressively being used in the outpatient setting to increase the musculoskeletal evaluation through visualization of the structures. Ultrasound may be used to evaluate for soft tissue abnormalities in commonly examined joints and structures. This technology is also now frequently used to guide injections, as it allows for improved placement of needles for distribution of treatment without exposure to ionizing radiation.

Spasticity management: spasticity is a common complication connected to CNS injury (e.g., SCI, stroke, cerebral palsy). Physiatrists treat spasticity by using oral ant spasticity agents, botulinum toxin injections, phenol injections, and intrathecal baclofen pump management to increase function and decrease pain.

Interventional spinal therapeutics: Image-guided spinal diagnostics and injections, as well as discograms, interlaminar and transforaminal epidurals, and radiofrequency ablations, spinal cord stimulation, vertebroplasty/kyphoplasty, and intrathecal pump placements. These treatments are being used as a nonsurgical pain-relieving intervention for back pain and radiculopathy.


Other PM&R treatment and procedures performed by some physiatrists include acupuncture, prolotherapy, platelet-rich plasma injections, and autologous stem cell treatments.

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