Master of Medicine Degree in Physical Medicine (Musculoskeletal) University of Sydney Physical Medicine Physical Medicine is defined as the management by medical practitioners of acute or chronic musculoskeletal injury, disease and dysfunction. Its aim is to address somatic dysfunction – impaired or altered function of related components of the somatic (body framework) system. This involves skeletal, arthrodial and myofascial structures with subsequent related vascular, lymphatic and neural elements (Hospital Adaptation of International Classification of Diseases, 2nd Edition, 1973, and International Classification of Diseases Version 10, Australian Modification). Treatment modalities are applied to restore normal function. The information below explains the skills of doctors currently working in Physical Medicine, the techniques they use and the knowledge acquired from extensive training.  Both the previous and current Diploma courses offer a strong grounding in musculoskeletal medicine and pain management. The skills taught are particularly relevant in spinal pain presentations, including back pain and referred pain syndromes. Differential diagnosis and recognition of pathology with musculoskeletal manifestations are emphasised, as are the risk factors associated with the development of chronic pain syndromes. Both courses aim to equip the medical doctor to develop an appropriate management program and apply or supervise therapy. Intervention may involve manual therapy, specific exercises, pharmacological management and injection technique, and if necessary, appropriate referral. Previously Physical Medicine doctors were trained by an initial two years of study, which lead to the Postgraduate Diploma in Physical Medicine offered by the University of Sydney.  It offered a general training in all aspects of musculoskeletal medicine, including anatomy, biomechanics, rheumatology, radiology, clinical examination and treatment, including manual and injection techniques. The course focused on the acquisition of practical clinical skills for the management of spinal and peripheral conditions. Theoretical, practical and clinical work of the first, two years included residential weeks, based in the Department of Anatomy and Histology on the main campus of The University of Sydney, usually held in February, July and November of each year. Coursework included: lectures, tutorials, practical classes (including gross anatomy laboratories), and clinical observation at out-patient rooms/departments. A broad, but directed, reading of relevant texts and journal articles was required prior to each residential week. Assessment was by assignments and written, specimen-based and clinical (viva voce) examination. The course leading to the Master of Medicine in Physical Medicine offered by the University of Sydney included a third year of study. The emphasis in the third year was the diagnosis and treatment of dysfunctions of posture and gait, and musculoskeletal pain management at an advanced level. Theoretical, practical and clinical work of the third year included two residential weeks at Royal North Shore Hospital, usually held in April and September. The pain management component is largely taught by modern distance education techniques via the internet.   This has now been organised to be  a Masters Degree in Musculoskeletal Medicine at Macquarie University over 2 years part time at the Australian School of Advanced Medicine.     The following pages contain the syllabus of this previous postgraduate Diploma and Masters Program: DIPLOMA IN PHYSICAL MEDICINE (MUSCULOSKELETAL) Summary of Courses        Subject     Semester 1  1.1 Anatomy of the axial skeleton 1 Lumbar, Thoracic, Cervical    1.2 Spinal Diagnosis 1               Semester 2  2.1 Radiological and other imaging in axial musculoskeletal disease    2.2 Systemic and Neoplastic Diseases    2.3 Pain    2.4 Rehabilitation    2.5 Pharmacology in Musculoskeletal Medicine    2.6 Advanced Spinal Diagnosis-assessment of referred pain due to intervertebral dysfunction    2.7 Clinical treatment of intervertebral dysfunction, the method of Dr R Maigne(University of Paris)    2.8 Biomechanics of axial skeleton    2.9 Manual treatment of axial skeleton, using North American and Swiss Manual Medicine techniques    2.10 Principles of corticosteroid injection   Semester 3 3.1 Myofascial Pain Syndrome/Injection Techniques   3.2 Anatomy of the TMJ, shoulder & hip girdles   3.3 Therapy approaches: Physiotherapy, Alexander, Acupuncture etc   3.4 Neuromuscular disorders   3.5 Gait   3.6 Physiology of Muscle & Exercise   Semester 4 4.1 Anatomy of the peripheral joints   4.2 Biomechanics of peripheral skeleton   4.3 Regional Disorders, Sports Injury   4.4 Manual treatment of peripheral skeleton Karltenborn & Evjenth   4.5 Clinical Assessment and treatment 2 - an integrated approach   4.6 Pelvis, Anatomy and Biomechanics   4.7 Methods for experimental investigation in musculoskeletal medicine. Statistics and epidemiology     Workplace Injury, Medico-legal reports   Semester 5 5.1 Neurobiology of Pain(CORE)   5.2 Pharmacology of Pain(CORE)   5.4 Neuromuscular Disorders 4 Affecting Posture and Gait   5.5 Posture Analysis   Semester 6 6.1 One of: Diagnostic Strategies in Pain Pain Management: Musculoskeletal Occupational Disability and Rehabilitation Pain Management: Neural Blockade: to be developed Pain Management: Acupuncture: to be developed Interventional Pain Management: (Residential) to be developed   6.2 Gait Analysis   6.3 Postural Dysfunction: Management           Elective Papers in Years 1 and 2 of the Degree course. One each year, each of 3-5,000 words (not including the reference list). The topic may be either clinical or pre-clinical, of the student’s own choice in the field of Physical Medicine (subject to approval by the academic coordinator). One paper to be completed each year. Assignment Year 3 of the Master of Physical Medicine (Musculoskeletal) Degree course. One assignment, of 10,000 words (not including the reference list). The topic may be either clinical or pre-clinical, of the student’s own choice in the field of Physical Medicine (subject to approval by the academic coordinator). Topics to be submitted for approval by May 1st. Completed papers to be submitted by 1st November.     MASTER OF MEDICINE IN PHYSICAL MEDICINE (MUSCULOSKELETAL) SYLLABUS: YEAR 3 Appendix A SUBJECT DESCRIPTIONS CORE SUBJECTS: PHYSICAL MEDICINE Neuromuscular Disorders affecting Posture and Gait This unit will consist of directed reading on diseases of the Motor System affecting posture and gait. These include diseases of the extrapyramidal system, the cerebellum, the upper and lower motor neurones. The emphasis is on clinical recognition of patients suffering these diseases. There will be required a short attendance at Neurology out Patient Clinic at Royal North Shore Hospital during the on campus week of semester 5.   Postural Dysfunction: Analysis The posture or structural examination is a static observation of the patient in the standing or sitting state. This is an extremely important part of the total examination process. Changes in postural alignment may be due to structural malformation, joint degeneration, a change in centre of gravity, poor postural habits or pain. A study of relevant texts and journal articles will be followed by a clinical teaching session held during the residential week. This unit will build upon the Physical Medicine knowledge gained in the first two years of the course, with a particular emphasis on postural muscle shortening or weakness. There will be required a short attendance at Neurology Out Patient Clinic at Royal North Shore Hospital during the on campus week of semester 5.   Gait Analysis Gait is the forward movement of the erect body, using the lower extremities for propulsion. Factors affecting gait include pain, weakness, abnormal range of motion and leg length discrepancy. A study of relevant journal articles and texts on gait disorders and gait analysis using video sequencing technology will be followed by practical teaching during the residential attendance week in Semester 6. This will be held at the new Gait Analysis Laboratory established in the Dept of Rehabilitation at RNSH.           Postural Dysfunction: Management This subject gives an overview of and evidence for therapeutic interventions including physical modalities such as manual treatment, exercise, orthoses and surgery. Attendence at Rehabilitation Department Out Patient Clinic at Royal North Shore Hospital will occur during the on campus week of semester 6. CORE SUBJECTS: PAIN COMPONENT Neurobiology of Pain This subject introduces and develops information on the basic neuroscience of pain. Neuroanatomical, physiological, pharmacological, biochemical origins of pain are considered, including the “injury response”. The integrating theme of the subject is