Musculoskeletal

July 2024 (New changes are coming for 2025/2026)

Rotation Lead: Dr. Jacqueline Stoller

The MSK rotation is a two-week outpatient rotation that takes place during the first two weeks of each block. It is comprised of five components:

1)      Sports Medicine clinic (Dr. Stoller/Dr. Zeldin)

2)      Rheumatology clinic (Dr. Dostrovsky/Dr. Potashner)

3)      Pain clinic (Dr. Perelman/Dr. Wansbrough)

4)      Physiotherapy (at Dr. Stoller’s clinic)

5)      Joint injection clinic with Dr. Zeldin

Rotation goals

1)      Develop an approach to managing common MSK conditions seen in Family Medicine.

2)      Improve their MSK physical exam skills.

3)      Introduction to common joint injections.

4)      Exposure to Rheumatology and pain clinics and know when to refer patients to these specialities.

Schedule

Below is a typical schedule for your MSK rotation. Sally and Dr. Lazare will confirm your schedule a minimum of two weeks prior to the start of the rotation.

Evaluation

Dr. Stoller will complete an ITER for each resident on POWER at the end of the rotation.

Vacation

Please try not to take vacation time during your MSK rotation given it is only two weeks long. However, if you do take vacation, please inform Dr. Stoller in advance. Where possible, we might be able to move your rotation to two weeks during the block where you are not taking vacation.

Half days back

Where possible, please skip your two half days back during your MSK block or do them on Fridays during physiotherapy clinic. Please ask your FM preceptors whether you can do two full days of half days back during your two elective weeks instead if they do not want you to miss your half days. If you must take half days during MSK block, please inform Sally and Dr. Lazare as early as possible so that the schedule can be amended.

MSK competencies

On this rotation, residents should work towards the following competencies:

1.      Utilize the competencies of a family physician when addressing musculoskeletal issues.

2.      . Conduct a screening musculoskeletal history* to identify: a) the presenting complaint b) any emergent signs and symptoms c) occupational MSK exposure

a)  Understand the significance of red and yellow flag* identification in the history for appropriate triage and management.

3.      Perform an appropriately thorough and focused musculoskeletal physical examination.

4.      Construct an appropriately thorough differential diagnosis for musculoskeletal conditions that is congruent with the data generated by the history and physical.

a)  Select appropriate diagnostic investigations* (i.e. radiography, ultrasound and MRI), if required, to support or refute differential diagnosis.

b)  Interpret diagnostic investigations for common conditions for prognosis and management.

5.      Recognize the typical and atypical presentation of common diagnoses as well as possible emergent life-threatening and/or limb-threatening disease.

6.      Demonstrate an evidence-based approach for appropriate care of common conditions, including non-pharmacological and pharmacological management, rehabilitation and discussion of management options*.

a)  Demonstrate understanding of the indications, contra-indications and side effect profile of medications.

b)  Describe the prescribing guidelines for opioid medications in non-cancer pain management.

c)      Determine appropriate return to activity, return to work and return to sport planning using evidence-based medicine in collaboration with the patient. 

d)  Understand the psychosocial impact that pain and disability have on patient outcome and care.

7.      Demonstrate an effective approach to the assessment of conditions benefiting from joint injection.

a)      Describe the indications and contraindications for common joint and bursa injections including shoulder, elbow and knee.  

b)      Perform a joint injection in the shoulder or knee with supervision.

8.      Understand the role of physiotherapy in the rehab protocol for patients with MSK conditions.

Contact information

Please see below for contact information for the various clinics.

Dr. Jacqueline Stoller

Athlete's Care: 801 York Mills Road, Suite 103a

Phone: (416) 479-8377

drjstoller@gmail.com

Dr. David Zeldin

Athlete's Care: 5095 Yonge St (Empress Walk)

Phone: (416) 479-8685

Monday afternoon hours: 1:30 – 5 pm

Thursday joint injection clinic hours: 2-5 pm

dazeldin@gmail.com

Paid parking underneath clinic. North York Centre subway station directly under clinic.

Dr. Nathaniel Dostrovsky/Dr. Wayne Potashner

4430 Bathurst Street, Suite 209

Phone: (416) 631-6090        

nathaniel.dostrovsky@nygh.on.ca

Parking lot behind the building off Cocksfield Ave. Use second entrance without a gate to access building.

Dr. Perelman/Dr. Wansbrough

Orthopedic Rehabilitation Institute

865 York Mills Rd, Suite 20

Phone: (647) 349-7880        

vsperelman@gmail.com