What is a Physiatrist?

A physiatrist (fizz ee at’ trist) is a physician specializing in Physical Medicine and Rehabilitation. Established as a medical specialty in the 1940s, Physical Medicine and Rehabilitation is a discipline primarily concerned with acute and chronic problems of the neuromusculoskeletal system. The goal of the physiatrist is to restore function and relieve pain in patients with a variety of disorders using a non-surgical multidisciplinary treatment approach.

To become a physiatrist, individuals must successfully complete four years of graduate medical education and four additional years of postdoctoral residency training. Residency training includes one year spent developing fundamental medical or surgical clinical skills and three additional years of dedicated training in the full scope of the specialty.

There are currently 79 accredited residency programs in physical medicine and rehabilitation in the United States. Many physiatrists choose to pursue additional fellowship training in a specific area of the specialty. Fellowships are now available for specialized study in areas such as spine and musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine. To become board-certified in physical medicine and rehabilitation, physiatrists are required to pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R).

Physiatrists may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists’ patients include people with arthritis, tendonitis, any kind of spinal pain, and work- or sports-related injuries. They are trained to perform electrodiagnostic studies in the evaluation of patients with disorders of the nervous or musculoskeletal systems. In addition, a select group of physiatrists have been fellowship trained to perform interventional spinal procedures utilizing fluoroscopic guidance.

Doctors who specialize in physiatry may practice in rehabilitation centers, hospitals, and in private offices. They can have broad practices, but many, like the physicians of Interventional Spine & Sports Medicine, P.C., choose to concentrate on a particular area of care such as spine and musculoskeletal medicine.

Thus, appropriately trained physiatrists such as Dr. Patel is uniquely qualified to diagnose and manage spinal and musculoskeletal conditions utilizing a comprehensive non-surgical treatment approach

To become a physiatrist, after four years of undergraduate training, individuals must then successfully complete four years of graduate medical education and four additional years of postdoctoral residency training. Residency training includes one year, often referred to as “internship”, spent developing fundamental clinical skills in the areas of internal medicine and/or general surgery. This year is followed by three additional years of dedicated training in the full scope of the specialty of physical medicine and rehabilitation (PM&R).

There are 79 accredited residency programs in physical medicine and rehabilitation in the United States. Many physiatrists choose to pursue additional advanced degrees (MS, PhD) or complete fellowship training in a specific area of the specialty. Fellowships are available for specialized study in such areas as musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine. Dr. Patel is fellowship trained in interventional spine and musculoskeletal medicine. Dr. Patel received their specialty training at one of the most highly regarded and sought after fellowship training programs at nationally recognized medical centers.

Following clinical training, to become board-certified in physical medicine and rehabilitation, physiatrists are required to pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R). The ABPM&R also has agreements with each of the boards of pediatrics, internal medicine, and neurology to allow special training programs leading to certification in both specialties.

Physiatrists who have completed the appropriate training and experience in particular areas of clinical expertise are also given the unique opportunity to pursue additional and subspecialty board certification. Such opportunities exist in the areas of pain medicine, sports medicine, spinal cord injury, pediatric rehabilitation, and soon, neuromuscular medicine.

Interventional Spine & Sports Medicine PC, is pleased to announce that Digital Subtraction Angiography (DSA) technology will be used at our state of the art procedural suite. During the performance of spinal injection procedures, even with the use of digital imaging and live contrast enhanced fluoroscopic imaging, it is possible that medication can enter small blood vessels which are not clearly visualized by the treating physician. When the steroid solution injected enters these small vessels, significant complications can result.

DSA imaging allows your treating physician to highlight these blood vessels during the performance of your injection procedure to be certain that only desirable medication flow patterns are achieved. DSA imaging is now utilized during all cervical injection procedures and during lumbar injection procedures performed at higher levels of the lumbar spine and when further visualization of contrast flow patterns is determined necessary.

The accompanying images demonstrate a cervical transforaminal selective nerve root injection (right C6 nerve root) performed with typical fluoroscopic visualization (image A), and after the incorporation of DSA technology (image B). DSA software achieves this complementary image by “subtracting” all surrounding structures except for the contrast injected. This allows your physician to clearly identify the flow of contrast and visualize any unwanted vascular flow which might be missed secondary to clouding by background structures. Fortunately, no unwanted vascular flow was identified in this case.

The interventional spine literature has recently highlighted the potential role of Digital Subtraction Angiography in minimizing complications resulting from vascular and arterial uptake during spinal injection procedures. At Interventional Spine & Sports Medicine, PC, we continually strive to utilize only evidence based treatment practices, the latest diagnostic and imaging technologies available, and most importantly, to maximize patient safety during each injection procedure performed

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