Introduction:

The Moses Cone Primary Care Sports Medicine Fellowship is a one-year ACGME accredited program, which allows primary care physicians to develop expertise in the area of sports medicine.  This is accomplished through teaching and supervision from the Moses Cone Family Medicine Residency Program, various Greensboro and Burlington Orthopedic and Primary Care physicians, and high school, collegiate, and professional teams and staff.  Sports medicine fellows will gain experience in sports preparticipation and health prevention, treatment of acute and chronic musculoskeletal injuries, sideline and mass participation sports medicine, and treatment of chronic disease in athletes.  Completion of the Fellowship allows the physician to sit for the Certificate of Added Qualification in Sports Medicine.

Medical Knowledge:

Goal - To gain the knowledge to evaluate, diagnose and manage common disorders seen in sports medicine and orthopedics.

Objectives - the fellow will be able to understand:

• Normal anatomy, physiology and biomechanics of the musculoskeletal and neurologic system.

• The pathology, pathophysiology, diagnosis and treatment of acute and chronic sports medicine and orthopedic injuries, including soft tissue, bone and nerve injury.

• The pathology and pathophysiology of acute and chronic medical illness in the active population.

• The psychological aspects of exercise, performance, and injury.

• Preventive medicine and the athletic preparticipation exam, including the ethical and medico-legal aspects.

• Physiology and pathophysiology of hydration, nutrition and the use of pharmacologic agents, including performance enhancing and mood-altering substances of athletes.

• How to diagnose and treat common acute and chronic sports medicine and orthopedic injuries:

Core Topics	AAFP	Wheeless Orthopedic Textbook	eMedicine (free)	UpToDate®
Spine
Cervical Disc Herniation		Cervical Disc Herniation	Cervical Disc Injury	1) Evaluation  2) Treatment
Lumbar Disc Herniation	1999 - Clinical Evaluation and Treatment Options for Lumbar Disc Herniation	Disc Herniation	Lumbosacral Disk Injury
LBP/ Lumbosacral Sprain	2007 - Evaluation and Treatment of Acute Low Back Pain Acute lumbar disk pain: Navigating evaluation & treatment choices (AFP 2008 Oct 1)	Low Back Pain in the Adult	Physical Exam on Low Back Pain (JAMA 1992)	1) Diagnosis & Evaluation  2) Initial Treatment
Spondylolysis/listhesis	2005 - Childhood and Adolescent Sports Related Overuse Injuries	Spondylolysis / Spondylolisthesis	Lumbosacral Spondylolysis
Shoulder
	Chronic Shoulder Pain: Part I. Eval & Dx (2008 Feb 15) Chronic Shoulder Pain: Part II. Rx (2008 Feb 15)			Evaluation of the patient with shoulder complaints (Anderson BC, 2008 Jun 17)
AC Sprain/ Separation		AC Joint Separation	AC Joint Injury	Acromioclavicular injury
Brachial Plexus Injury	1999 - The Burner: A Common Nerve Injury in Contact Sports	Transient Brachial Plexopathy and CCN	Brachial Plexus Injury (Updated 2006 Sep 5)	Burners (Stingers):  Acute peripheral nerve injury in the athlete
Capsulitis, Adhesive	1999 - Adhesive Capsulitis: A Sticky Issue	Adhesive Capsulitis of the Shoulder		Frozen Shoulder
Clavicular Fracture	2004 - Acute Shoulder Injuries	Clavicle Fracture
Impingement		Shoulder Impingement Syndrome	Shoulder Impingement	Shoulder Impingement Syndrome
Rotator Cuff Tendinopathy			Rotator Cuff Injury	Rotator Cuff Tear (Simons 2008 Apr 22)
Shoulder Instability	1999 - Shoulder Instability in Younger Athletes	Anterior Instability of the Shoulder	Clavicular Injury	Multidirectional Instability of the Shoulder
Elbow
	2000 - Evaluation of Elbow Overuse Injuries			Evaluation of the Patient with Elbow Pain Elbow Injuries in the Young Athlete
Lateral Epicondylitis	2007 - Clinical Evidence Concise:  Tennis Elbow (treatment only)	Lateral Epicondylitis	Lateral Epicondylitis	Epicondylitis
Medial Epicondylitis		Medial Epicondylitis	Medial Epicondylitis	Epicondylitis
Hand / Wrist
	2005 - A Clinical Approach to Diagnosing Wrist Pain 2004 - Hand and Wrist Injuries Part I: Nonemergent Evaluation 2004 - Hand and Wrist Injuries Part II: Emergent Evaluation 2006 - Acute Finger Injuries Part I:  Tendons and Ligaments 2006 - Acute Finger Injuries Part II: Fractures, Dislocations, Thumb Injuries		Radius, distal fractures (updated 2007 Nov)	Evaluation of the Patient with Wrist Pain Evaluation of the Patient with Hand Pain Evaluation of the Patient with Thumb Pain
Carpal Tunnel Syndrome	2003 - Management of Carpal Tunnel Syndrome	Carpal Tunnel Syndrome		1) Clinical Manifestations 2) Treatment
DeQuervain's Tenosynovitis		DeQuervain's Disease		DeQuervain's Tenosynovitis
Mallett Finger		Mallet Deformity	Mallet Finger
Scaphoid Fracture	2004 - Diagnosis and Management of Scaphoid Fractures	Scaphoid Fracture		Scaphoid Fractures in Adults
Trigger Finger	2003 - Diagnostic and Therapeutic Injection of the Wrist and Hand	Trigger Finger / Tenosynovitis		Trigger Finger (flexor tenosynovitis)
Hip / Pelvis
	1999 - Anterior Hip Pain 2000 - Hip Pain in Athletes 2003 - Evaluation & Management of Hip Pain			Evaluation of the Adult with Hip Pain
Hip Osteoarthritis	2002 - Osteoarthritis: Diagnosis & Therapeutic Considerations	Osteoarthritis		Clinical Manifestations of Osteoarthritis (multi-site)
Piriformis	Hip pain in athletes (2000 Apr 1)		Piriformis syndrome (updated 2006 Aug)
Trochanteric Bursitis			Trochanteric Bursitis Hip tendonitis and bursitis (updated 2008, Mar)	Trochanteric Bursitis
Knee
	2003 - Evaluation of Patients Presenting with Knee Pain:  Part I 2003 - Evaluation of Patients Presenting with Knee Pain:  Part II 2005 - POC Guides:  Evaluating the Patient with a Knee Injury 2000 - Acute Knee Effusions:  A Systematic Approach to Diagnosis			Evaluation of the Adult Patient with Knee Pain Causes of Knee Pain & Injury in the Young Athlete Approach to the Young Athlete with Acute  Knee Pain or Injury Young Athlete Treatment of Knee Injuries in the Athlete
ACL Tear		ACL	ACL Injury
ITB	2005 - ITB:Common Source of Knee Pain	Iliotibial Band Syndrome	Iliotibial Band Syndrome
Knee Osteoarthritis	Osteoarthritis: Dx & therapeutic considerations (AFP 2002 Mar 1) Intra-articular hyaluronic acid injections (AFP 2000 Aug 1)	Osteoarthritis of the Knee		Clinical Manifestations of Osteoarthritis (Kalunian KC, UpToDate® 2007 May 21)
MCL / LCL Tear		LCL and MCL	MCL and LCL Injury
Meniscal Tear		Meniscii	Meniscus injuries (2008 Jun 5)	Meniscal Injury of the Knee
OCD	2000 - Osteochondritis Dissecans: A Diagnosis not to Miss	OCD and Osteochondral Lesions	Knee OCD
Patellofemoral Pain	2007 - Management of Patellofemoral Pain Syndrome A Review & Guidelines for treatment (AFP 1999 Nov 1: 2012-22)		Patellofemoral Joint Syndrome	Patellofemoral Pain Syndrome (Juhn MS, UpToDate® 2008 Jan 28)
Patellar/Quad Tendonitis		Jumpers Knee	Jumper's Knee
PCL Tear		PCL	PCL Injury
Foot / Ankle
	2004 - POC Guides: Evaluating the Patient with an Ankle or Foot Injury Foot fractures frequently misdiagnosed as ankle sprains (2002 Sept 1)			Evaluation of Foot & Ankle Pain in the Young Athlete Clinical Features & Management of Ankle Pain in the Young Athlete
Ankle Sprain	2006 - Acute Ankle Sprain: An Update 2002 - Foot Fractures Frequently Misdiagnosed as Ankle Sprains	Ankle Sprain	Ankle Sprain	Ankle Sprain
Ankle Tendonitis	2002 - Common Conditions of the Achilles Tendon	Achilles Tendonitis / Tendonosis	Achilles Tendonitis	Posterior ankle tendinopathies (Sheon RP, UpToDate® 2007 Apr 25)
Metatarsalgia		Metatarsalgia	Metatarsalgia
Morton's Neuroma		Morton's Neuroma		Nerve Entrapment Syndromes of the Leg & Foot
MTSS / Tibial Stress Fracture	2003 - Common Stress Fractures Management & return to play of stress fractures. (Clin J Sports Med;2005,15(6):442-7)	MTSS and Tibial Stress Fractures		Stress Fracture of the Tibia & Fibula
Plantar Fasciitis	2005 - Plantar Fasciitis: EBM Review of Diagnosis and Therapy	Plantar Fasciitis	Plantar Fasciitis (updated 2008 Jan)	Plantar Fasciitis & Other Causes of Heel & Sole Pain
Peds
	2005 - Childhood and Adolescent Sports Related Overuse Injuries
Legg-Calve-Perthes		Perthes Disease
Little League Elbow	Little League Elbow, Clin J Sports Med 2005: 15 (1): 37-40		Little League Elbow
Osgood Schlatter	2005 - Childhood and Adolescent Sports Related Overuse Injuries	Osgood Schlatter Lesion	Osgood Schlatter Disease	Osgood Schlatter Disease
SCFE	1998 - Slipped Capital Femoral Epiphysis	SCFE	SCFE	Slipped Capital Femoral Epiphysis
Advanced Topics for Sports Medicine Fellowship	Journal Articles	Evidence Based Reviews	Images, Pictures, Video, Powerpoint	Cases
	Commonly Missed Ortho - AAFP		Radiology Resources
Head & Spine
Cervical Spinal Stenosis
Concussion and Head Injury	Cumulative Effects Associated with Recurrent Concussion (JAMA 2003) 2004 - Management of Sport-Related Concussion 2001 - Concussion in Sport 2004 - Concussion in Sport Management of Head and Neck Injuries by the Sideline Physician (AFP 2006 Oct 15)		C-Spine EMER Med
HNP/Nerve Impingement of C-spine
HNP/Nerve Impingement of Lumbar Spine
Low Back Pain	2002 - Exercise & PT for Chronic Low Back Pain 2002 - Most Effective Rx for Acute Low Back Pain	2005 - Exercise Rx for Nonspecfic Low Back Pain 2003 - Overnight Use of Continuous Low-Level Heatwrap Rx 2005 - Primary Care Interventions to Prevent Low Back Pain in Adults Controlled Trial of Corticosteroid Injections - NEJM Outcomes & Costs in Primary Care - NEJM
Lumbar Spinal Stenosis			Lumbar Spinal Stenosis
Shoulder
Humerus Fracture	Pitfalls of UE Imaging I - AAFP Pitfalls of UE Imaging II - AAFP
Labrum Injury
Rotator Cuff Tear	Point-of-Care Guides: Diagnosing rotator cuff tears (2005 Apr 15) Rotator Cuff Injury (eMedicine 2006 Jun 8)	Rotator Cuff Tears	Rotator Cuff Tears (AAOS last update Oct 2007)
Shoulder Dislocation/ Subluxation	Need for radiographs in cases of shoulder dislocation (AFP 2001 Feb 15)	Surg vs. Conservative (Cochrane)
Elbow
	Elbow injuries In throwing athletes (Amer J Sp Med 2003, 31:621)
Elbow Fractures			Elbow fractures (CHORUS, CE Kahn, Univ WI)
Wrist
Distal Radius Fractures
TFCC Injury
Wrist Sprain	Hand & Wrist Injury - Part I (AFP 2004 Apr 15) Hand & Wrist Injury - Part II (AFP 2004 Apr 15)
Hand
Carpal Fractures
Central Slip Injury
Gamekeepers Thumb				Thumb Sprain Case
Intercarpal Ligament Tears
Jersey Finger
Metacarpal Fractures (Hand)		Boxer's fracture (metacarpal neck) - Wheeless' Orthopedic Textbook
Phalangeal Capsular Sprain	Acute Finger Injuries: Part I. Tendons & Ligaments (AFP 2006 Mar 1) Finger Injuries Part II (AFP)
Phalangeal Fractures (Hand)
Hip
Avulsion Fractures of Hip
Femur Fractures	Hip Fractures in Adults (AFP 2003 Feb 1)
Osteitis Pubis
SI Dysfunction				;
Knee
Iliotibial Band Friction Syndrome	2006 - Iliotibial Band friction syndrome in runners 2004 - Local corticosteroid injection
MCL/LCL Injury
Meniscal Tears
Patellar Tendinosis		Achilles tendon rupture (Wheeless' Orthopedic Textbook)	Patellar Tendinosis: Acute tendon rupture & Jumper’s Knee (Phys & Sportsmed, 2004 May)
Lower Leg
Compartment Syndrome	Compartment Syndromes (eMedicine 2006 Nov 30)
Endurance Athletes	Common problems in endurance athletes (AFP 2007 Jul 15) Iron as an Ergogenic Aid: Ironclad Evidence? Current sports medicine reports. 2007; 6(4):258.
Fibula Fractures
Shin Splints				NISMAT Physical Therapy Corner: Shin Splints (Pt Exercises)
Tibial Stress Fractures	Management and Return to Play of Stress Fractures. Clinical Journal of Sports Medicine; 2005 15(6):442-447
Foot/ Ankle
Achilles Tendonitis	Common overuse tendon problems: A review & recommendations for treatment (AFP 2005 Sep 1)			NISMAT Physical Therapy Corner: Shin Splints (Pt Exercises)
Ankle Fractures
Ankle Tendonitis
Bunions	Corns & calluses resulting from mechanical hyperkeratosis (AFP 2002 June 1)
Calcaneal Apophysitis	2000 - Sever's Disease & Other Causes of Heel Pain in Adolescents
Foot Fractures, Sprains & Dislocations	Management of ankle sprains (AFP 2001 Jan 1)	2002 - Foot Fractures Frequently Misdiagnosed	1998 - Lisfranc Injury
Hallux Rigidus
Metatarsal Fracture	Metatarsal stress fracture (eMedicine updated 2007 Sep)
Navicular Fracture
Pes Cavus
Pes Planus
Phalanx Fracture (Foot)	Toe fractures (Gravlee JR, UpToDate® 2006 Jan 12)
Plantar Fasciitis		1998 - Treatments for Plantar Heel Pain 2003 - Fascia-Stretching Exercise for Chronic Heel Pain
Syndesmosis Injury			High Ankle Sprains: Minimizing the frustration of a prolonged recovery (Physician & Sportsmed 2004 Dec)
Tarsal Tunnel	Diagnosing heel pain in adults (AFP 2004 Jul 15)
Other Topics
Bone Tumors
Brugada Syndrome		Long-Term follow-up of individuals with the electrocardiographic pattern of RBBB & ST-seg elevation in precordial leads V1 - V3 Natural history of Brugada syndrome
Exercise Induced Asthma	Recognition & mgt (AFP 2003 Feb 15) Exercise-induced asthma (eMedicine, updated 2007 Nov)
Heart Problems in Athletes	Practice Guidelines: ACC Statement on preparticipation cardiovascular screening for competitive athletes (AFP 2005 Aug 1)	Clinical significance of abnormal ECG patterns in trained athletes (Circ 2000 July 18) Twenty-four hour continuous ECG during exercise & free activity in 80 Apparently Healthy Runners (Am J Cardiol 1983 Oct 1) Prevalence & nature of cardiac arrhythmias in apparently normal well-trained runners (Am Heart J 1982, Oct) 36th Bethesda Conf: Eligibility recommendations for competitive athletes with cardiovascular abnormalities (J Am Coll Cardiol 2005; 45 no. 8) 36th Bethesda Conf: Preparticipation screening and diagnosis of cardiovascular disease in athletes (J Am Coll Cardiol 2005; 45 no. 8) Congenital Heart Disease Valvular Heart Disease 36th Bethesda Conf: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, & Marfan syndrome (J Am Coll Cardiol 2005, 45 no. 8) Systemic Hypertension Coronary Artery Disease Arrhythmias Classification of Sports Drugs & performance-enhancing substances Automated external defibrillators Commotio Cordis Legal Aspects of the 36th Bethesda Conference Recommendations (J Am Coll Cardiol 2005, 45 no. 8) Clinical significance of abnormal electrocardiographic patterns in trained athletes (Circulation 2000,102:278-284) 24-Hour Continuous electrocardiography during exercise & free activity in 80 apparently healthy runners Prevalence & nature of cardiac arrhythmias in apparently normal well-trained runners Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: Proposal for a common European protocol		Case Study 26 2005 Case Studies (ppt lecture)
Hyponatremia	Statement of the 2nd International Exercise-Associated Hyponatremia Consensus Development Conference, 2007 (Clin J Sports Med 2008,18:111)
Nutrition & Supplements	Supplements & sports (AFP 2008 Nov 1)	Glucosamine therapy for treating osteoarthritis (Cochrane)
Pediatrics			Childhood & adolescent sports-related overuse injuries (AFP 2006 Mar 15)
Sudden Cardiac Death in Athletes

Patient Care:

Goal - To develop the skills to manage common orthopedic and sports medicine disorders seen in primary care.

Objectives - the fellow will be able to:

• Obtain accurate histories regarding orthopedic and sports medicine diseases.
• Perform appropriate physical examinations on patients with musculoskeletal conditions:

• Care for athletes with acute and chronic medical illnesses
• Perform preparticipation examinations, including counseling and rehabilitation for return to play and sports exclusion.
• Perform a wellness assessment and counsel patients regarding hydration, nutrition, performance enhancing substances and rehabilitation.
• Act as team physician for various sports teams and mass participation events including managing acute and life-threatening injuries and illnesses.
• Continue managing primary care patients, including continuity clinics and precepting residents and students.
• Perform procedures appropriate for the diagnosis and management of musculoskeletal disorders:

Interpersonal & Communications Skills:

Goal - To communicate effectively with physicians, staff, and patients concerning the evaluation and management of orthopedic and sports medicine conditions.

Objectives - the fellow will be able to:

• Describe the diagnosis and treatment plans for diagnosed conditions to patients and their families.
• Counsel patients regarding their injury and incorporate return to play and prevention strategies.
• Accurately convey medical information to colleagues, specialists, athletic trainers and coaches, verbally and written.
• Accurately document patient encounters.

Practice-Based Learning & Improvement:

Goal -  To appraise and utilize the best evidence in caring for patients with or at risk for various orthopedic and sports medicine conditions.

Objectives - the fellow will be able to:

• Integrate evidence based medicine and new diagnostic or therapeutic strategies into patient care
• Analyze and present current literature in the field of sports medicine and orthopedics on a local and national level.
• Develop a research project or assist with on going research and publication. 
• Teach at journal club, noon conference and sports medicine seminar, knowledge that can be applied to patients and athletes by other learners. 
• Attend national sports medicine and orthopedic conferences and apply learned material to patient care.

Systems Based Practice:

Goal - To work well within the health care system to provide optimum care for patients with orthopedic or sports medicine conditions.

Objectives - the fellow will be able to:

• Appropriately utilize consultation with specialists for the co-management of sports medicine and orthopedic disorders. 
• Appropriately utilize imaging techniques at local imaging offices.
• Appropriately utilize special services such as physical and occupational therapy.
• Care for patients in a cost effective manner.
• Streamline the care of athletes between school and the health system and identify accessible resources for their care.
• Understand coding for sports medicine and orthopedic office visits, procedures, and supplies.
• Understand insurance requirements and reimbursement for sports medicine and orthopedic conditions and supplies, including worker's compensation.

Professionalism:

Goal - To demonstrate commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diversity when dealing with orthopedic and sports medicine problems.

Objectives - the fellow will be able to:

• Demonstrate respect and sensitivity in dealing with patients, regardless of race, cultural background or sexual orientation.
• Demonstrate good work habits including maturity, punctuality, availability and efficiency. 
• Reliably perform duties including clinic, training room and athletic event coverage. 
• Be available by pager for trainers, staff, colleagues and athletes.
• Provide adequate continuity and follow-up of athletes and complex cases.