A 64-year-old female named Anne sought relief of her bilateral knee pain due to osteoarthritis. She went to her primary care physician, an internist, for an evaluation. Based on his history and physical examination, he recommended that she see an orthopedic surgeon for a knee replacement. Scared to undergo surgery, Anne decided to consult a MSR-supported physiatrist for a second opinion.
Based on his history and examination, he felt a more complete diagnostic workup was in order. Bilateral knee x-rays with weight bearing views confirmed the diagnosis of osteoarthritis, but the severity was of a moderate nature - so alternate treatments were a distinct possibility.
Using evidence-based medicine principles, the physiatrist instituted a pyramidal approach to treatment. First, he counseled the patient regarding diet and exercise for weight loss. Second, he initiated a physical therapy program using pain relieving modalities and therapeutic exercises to strengthen the supporting muscles and structures of Anne's knees. Third, he prescribed topical and oral medications to treat osteoarthritis and reduce her pain. Finally, the physiatrist offered viscosupplementation of injection therapy.
Upon completing her course of physical therapy and medications, as well as receiving injection treatment, Anne reported significant relief of her pain and improvement of function. Her ability to walk her dog, play with her grandchildren and go shopping with friends made her grateful for the care she received. The ability of a specialist in Physical Medicine and Rehabilitation (PM&R) to provide multidisciplinary and multimodal care, as well as the ability to focus on patient function and the patient as a whole separates the physiatrist from other medical specialties. It is what makes the physiatrist a unique provider of medical care.
Case study by Raj Tolat, M.D.
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