What is a Physiatrist/ Physical Medicine and Rehabilitation Specialist?
A physiatrist, or rehabilitation physician, is a medical doctor who has also completed five years of residency training in the medical specialty of physical medicine and rehabilitation (PM&R). This physician is a nerve, muscle, bone and brain expert who treats injury or illness non-surgically to decrease pain, optimize motion and restore function. The primary goal of a Physiatrist is to look at the whole person and not just one symptom or condition in order to maximize quality of life.
This has been modified from the aapmr.org website.
Neuromusculoskeletal Clinic (NMSK)
The ability to move is greatly affected by injury or illness to nerve, muscle, bone and brain. The purpose of this clinic is to accurately identify an accurate diagnosis using detailed history, physical examination, and diagnostic investigations.
Dr Rambaransingh has a particular interest in using ultrasound as both a diagnostic and guided interventional tool for neuromusculoskeletal conditions and injury.
Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).
Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets.
An EMG uses tiny devices called electrodes to transmit or detect electrical signals.
During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle.
A nerve conduction study, another part of an EMG, uses electrodes taped to the skin (surface electrodes) to measure the speed and strength of signals traveling between two or more points.
EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.” – www.mayoclinc.org
Interventional Ultrasound Clinic
Ultrasound has dramatically changed the landscape of musculoskeletal medicine. It allows us to make diagnoses and treat muscle, tendon, ligament, joint, and nerve pathology precisely – without radiation exposure. Diagnoses can be made by comparing sides, dynamically assessing the structure in question, and/or using Doppler ultrasound.
Ultrasound guides interventions with sub-millimetre resolution. It allows us to target damaged or injured areas with precision. This ultimately leads to procedures that are more effective, safe, and efficient than current standard of care.
Ultrasound Guided Interventions
- Trigger Point Injection: This technique provides mechanical release and irrigation of trapped inflammatory mediators in muscle. Various solutions can be used with various durations of effect.
- Diagnostic Blocks: This technique is useful for localizing pain generators that are not localized with imaging.
- Cortisone Injections: These injections are helpful for reducing inflammation in or around anatomic structures.
- Viscosupplementation: Hyaluronic acid is a synthetic synovial fluid that can be injected in to the joint with mild to moderate osteoarthritis.
- Paratenon Stripping: Type 1 tendons (e.g. Achilles and patella) are painful due to neovascularization and sympathetic nerve in-growth. Sclerosing therapy allows one the breaking of these connections without compromising the integrity of the tendon.
- Hydrodissection/Decompression of Peripheral Nerves: Fluid propulsion from a needle can free the nerve from scar tissue attached to adjacent structures.
- Regenerative Injection Therapies: These therapies promote the healing cascade in hypovascular structures (e.g. rotator cuff, hamstring, and gluteus tendons).
- Dry Needling: This technique creates controlled inflammation and initiates the healing cascade with needle fenestration of the damaged structure.
- Prolotherapy: This technique uses hypertonic dextrose, which is irritating to the body, to create an inflammatory process that initiates the healing cascade.
- Autogolous Blood: The injection of whole blood initiates an inflammatory process & promotes the healing cascade.
- Platelet Rich Plasma: The process of spinning whole blood in a centrifuge allows one to separate platelets and inflammatory mediators (e.g. IL-6 and COX-2) from red blood cells. The concentrated solution is then placed into the damaged structure with ultrasound guidance.