\n<\/p>\n
April 18, 2026<\/p>\n
3 min read<\/p>\n<\/p><\/div>\n
\n \n \n Add topic to email alerts \n <\/span> \n <\/p>\n\n\n \n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nMusculoskeletal issues can typically be diagnosed on clinical exam.<\/li>\nPhysical therapy is the mainstay treatment. Corticosteroids can be used to supplement \u2014 not replace \u2014 physical therapy.<\/li>\n<\/ul>\nSAN FRANCISCO \u2014 Most musculoskeletal issues can be managed in primary care as they typically do not require complex imaging or immediate specialist referral, according to a speaker here.<\/p>\nCommon musculoskeletal conditions include lateral hip pain, anterior knee pain, ankle inversion injuries, shoulder pain, stiff shoulders and lateral elbow pain, Joshua <\/b>T. <\/b>Goldman, MD, MBA,<\/b> associate clinical professor in the division of sports medicine at the University of California, Los Angeles, told attendees at ACP\u2019s Internal Medicine Meeting.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Ankle sprains accounted for about 7% to 10% of ED visits, according to Joshua T. Goldman, MD, MBA. <\/strong>Image: Adobe Stock<\/em> \n <\/figcaption> \n <\/figure>\nUnderstanding how to diagnose and manage these conditions can potentially reduce ED overuse. For example, \u201cone ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we\u2019re trying to declutter our ERs, this is a good place to start,\u201d Goldman said.<\/p>\nHe outlined some practical tips for primary care physicians to keep in mind when approaching musculoskeletal injuries:<\/p>\n\n Most diagnoses <\/b>can be made with a <\/b>clinical<\/b> exam<\/b>.<\/b> Goldman advised primary care providers to \u201ctrust your targeted history and exam.\u201d Although imaging is a helpful adjunct, advanced imaging may show abnormalities not related to the patient\u2019s symptoms. For example, he said \u201cthere\u2019s nothing more terrifying than MRI\u2019ing the foot of a middle-aged runner. You\u2019re going to see a lot of bad stuff in there. I warn patients … it\u2019s going to look bad. Don\u2019t freak out.\u201d<\/li>\n \u201c<\/b>-i<\/b>tis<\/b>\u201d<\/b> is often a misnomer.<\/b> Many conditions are not primarily inflammatory but instead are often caused by tissue degeneration, Goldman said. For example, \u201cgreater trochanteric pain syndrome is actually gluteal tendinosis, and lateral epicondylitis is actually common extensor tendinosis,\u201d he said. \u201cWhen we start to reframe what that pathology is, the treatment starts to make more sense.\u201d<\/li>\n Biomechanics drive symptoms.<\/b> Underlying mechanical issues like muscle weakness are often the root cause of pain. Passive interventions alone cannot resolve the issue; the biomechanics need to be corrected, Goldman said.<\/li>\n \u201c<\/b>Physical therapy <\/b>is the<\/b> cornerstone of treatment.<\/b>\u201d Most patients with musculoskeletal issues benefit from physical therapy, according to Goldman. But PCPs must \u201cbe specific, be prescriptive and be targeted” in what they want the physical therapist to work on, not just \u201c\u2018PT, shoulder pain,\u2019\u201d he said. Tendons in particular need \u201ceccentric and progressive loading,\u201d Goldman said. \u201cWe\u2019re taught if it hurts, don\u2019t do it. We say that a lot to patients about their pathologies. Tendons are the exception. You need to grit it out, because if you don\u2019t load the tendon, it\u2019s not going to repair …. Soreness is actually part of that healing process.\u201d<\/li>\n Corticosteroid<\/b>s <\/b>are \u201cuseful but limited.\u201d <\/b>Although they provide pain relief, corticosteroid injections often have inferior long-term outcomes, \u201cespecially for tendon pathology,\u201d Goldman said. \u201cFor a long, long time, we believed they were curative, [which is] not true,\u201d he added. Goldman recommended using corticosteroid injections as an adjunct to physical therapy, not as a replacement, \u201cwith the exception of frozen shoulder, specifically.\u201d<\/li>\n Early mobilization is better than immobilization.<\/b> The traditional \u201crest, ice, compression and elevation\u201d approach can be used \u201cfor a little bit,\u201d but Goldman said \u201cyou have got to get moving.\u201d For ankle sprains specifically, \u201cwe need to strengthen [and] fix the biomechanics,\u201d he said. \u201cGive them a little supportive care with an ankle brace for that first week, but then you have got to get them out and get them into rehab.\u201d<\/li>\n \u201c<\/b>Know when to escalate care.<\/b>\u201d<\/b> Goldman advised referring patients to a specialist when they are not improving with structured rehabilitation or if there is concern about structural pathology like a tendon tear. \u201cGet your advanced imaging. Feel free to refer them on for additional care,\u201d he said. \u201cI always tell my fellows, if you look at an X-ray and you freak out, just send it to somebody else. That\u2019s totally fine.\u201d<\/li>\n<\/ul>\n
\n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nMusculoskeletal issues can typically be diagnosed on clinical exam.<\/li>\nPhysical therapy is the mainstay treatment. Corticosteroids can be used to supplement \u2014 not replace \u2014 physical therapy.<\/li>\n<\/ul>\nSAN FRANCISCO \u2014 Most musculoskeletal issues can be managed in primary care as they typically do not require complex imaging or immediate specialist referral, according to a speaker here.<\/p>\nCommon musculoskeletal conditions include lateral hip pain, anterior knee pain, ankle inversion injuries, shoulder pain, stiff shoulders and lateral elbow pain, Joshua <\/b>T. <\/b>Goldman, MD, MBA,<\/b> associate clinical professor in the division of sports medicine at the University of California, Los Angeles, told attendees at ACP\u2019s Internal Medicine Meeting.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Ankle sprains accounted for about 7% to 10% of ED visits, according to Joshua T. Goldman, MD, MBA. <\/strong>Image: Adobe Stock<\/em> \n <\/figcaption> \n <\/figure>\nUnderstanding how to diagnose and manage these conditions can potentially reduce ED overuse. For example, \u201cone ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we\u2019re trying to declutter our ERs, this is a good place to start,\u201d Goldman said.<\/p>\nHe outlined some practical tips for primary care physicians to keep in mind when approaching musculoskeletal injuries:<\/p>\n\n Most diagnoses <\/b>can be made with a <\/b>clinical<\/b> exam<\/b>.<\/b> Goldman advised primary care providers to \u201ctrust your targeted history and exam.\u201d Although imaging is a helpful adjunct, advanced imaging may show abnormalities not related to the patient\u2019s symptoms. For example, he said \u201cthere\u2019s nothing more terrifying than MRI\u2019ing the foot of a middle-aged runner. You\u2019re going to see a lot of bad stuff in there. I warn patients … it\u2019s going to look bad. Don\u2019t freak out.\u201d<\/li>\n \u201c<\/b>-i<\/b>tis<\/b>\u201d<\/b> is often a misnomer.<\/b> Many conditions are not primarily inflammatory but instead are often caused by tissue degeneration, Goldman said. For example, \u201cgreater trochanteric pain syndrome is actually gluteal tendinosis, and lateral epicondylitis is actually common extensor tendinosis,\u201d he said. \u201cWhen we start to reframe what that pathology is, the treatment starts to make more sense.\u201d<\/li>\n Biomechanics drive symptoms.<\/b> Underlying mechanical issues like muscle weakness are often the root cause of pain. Passive interventions alone cannot resolve the issue; the biomechanics need to be corrected, Goldman said.<\/li>\n \u201c<\/b>Physical therapy <\/b>is the<\/b> cornerstone of treatment.<\/b>\u201d Most patients with musculoskeletal issues benefit from physical therapy, according to Goldman. But PCPs must \u201cbe specific, be prescriptive and be targeted” in what they want the physical therapist to work on, not just \u201c\u2018PT, shoulder pain,\u2019\u201d he said. Tendons in particular need \u201ceccentric and progressive loading,\u201d Goldman said. \u201cWe\u2019re taught if it hurts, don\u2019t do it. We say that a lot to patients about their pathologies. Tendons are the exception. You need to grit it out, because if you don\u2019t load the tendon, it\u2019s not going to repair …. Soreness is actually part of that healing process.\u201d<\/li>\n Corticosteroid<\/b>s <\/b>are \u201cuseful but limited.\u201d <\/b>Although they provide pain relief, corticosteroid injections often have inferior long-term outcomes, \u201cespecially for tendon pathology,\u201d Goldman said. \u201cFor a long, long time, we believed they were curative, [which is] not true,\u201d he added. Goldman recommended using corticosteroid injections as an adjunct to physical therapy, not as a replacement, \u201cwith the exception of frozen shoulder, specifically.\u201d<\/li>\n Early mobilization is better than immobilization.<\/b> The traditional \u201crest, ice, compression and elevation\u201d approach can be used \u201cfor a little bit,\u201d but Goldman said \u201cyou have got to get moving.\u201d For ankle sprains specifically, \u201cwe need to strengthen [and] fix the biomechanics,\u201d he said. \u201cGive them a little supportive care with an ankle brace for that first week, but then you have got to get them out and get them into rehab.\u201d<\/li>\n \u201c<\/b>Know when to escalate care.<\/b>\u201d<\/b> Goldman advised referring patients to a specialist when they are not improving with structured rehabilitation or if there is concern about structural pathology like a tendon tear. \u201cGet your advanced imaging. Feel free to refer them on for additional care,\u201d he said. \u201cI always tell my fellows, if you look at an X-ray and you freak out, just send it to somebody else. That\u2019s totally fine.\u201d<\/li>\n<\/ul>\n
“ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nMusculoskeletal issues can typically be diagnosed on clinical exam.<\/li>\nPhysical therapy is the mainstay treatment. Corticosteroids can be used to supplement \u2014 not replace \u2014 physical therapy.<\/li>\n<\/ul>\nSAN FRANCISCO \u2014 Most musculoskeletal issues can be managed in primary care as they typically do not require complex imaging or immediate specialist referral, according to a speaker here.<\/p>\nCommon musculoskeletal conditions include lateral hip pain, anterior knee pain, ankle inversion injuries, shoulder pain, stiff shoulders and lateral elbow pain, Joshua <\/b>T. <\/b>Goldman, MD, MBA,<\/b> associate clinical professor in the division of sports medicine at the University of California, Los Angeles, told attendees at ACP\u2019s Internal Medicine Meeting.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Ankle sprains accounted for about 7% to 10% of ED visits, according to Joshua T. Goldman, MD, MBA. <\/strong>Image: Adobe Stock<\/em> \n <\/figcaption> \n <\/figure>\nUnderstanding how to diagnose and manage these conditions can potentially reduce ED overuse. For example, \u201cone ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we\u2019re trying to declutter our ERs, this is a good place to start,\u201d Goldman said.<\/p>\nHe outlined some practical tips for primary care physicians to keep in mind when approaching musculoskeletal injuries:<\/p>\n\n Most diagnoses <\/b>can be made with a <\/b>clinical<\/b> exam<\/b>.<\/b> Goldman advised primary care providers to \u201ctrust your targeted history and exam.\u201d Although imaging is a helpful adjunct, advanced imaging may show abnormalities not related to the patient\u2019s symptoms. For example, he said \u201cthere\u2019s nothing more terrifying than MRI\u2019ing the foot of a middle-aged runner. You\u2019re going to see a lot of bad stuff in there. I warn patients … it\u2019s going to look bad. Don\u2019t freak out.\u201d<\/li>\n \u201c<\/b>-i<\/b>tis<\/b>\u201d<\/b> is often a misnomer.<\/b> Many conditions are not primarily inflammatory but instead are often caused by tissue degeneration, Goldman said. For example, \u201cgreater trochanteric pain syndrome is actually gluteal tendinosis, and lateral epicondylitis is actually common extensor tendinosis,\u201d he said. \u201cWhen we start to reframe what that pathology is, the treatment starts to make more sense.\u201d<\/li>\n Biomechanics drive symptoms.<\/b> Underlying mechanical issues like muscle weakness are often the root cause of pain. Passive interventions alone cannot resolve the issue; the biomechanics need to be corrected, Goldman said.<\/li>\n \u201c<\/b>Physical therapy <\/b>is the<\/b> cornerstone of treatment.<\/b>\u201d Most patients with musculoskeletal issues benefit from physical therapy, according to Goldman. But PCPs must \u201cbe specific, be prescriptive and be targeted” in what they want the physical therapist to work on, not just \u201c\u2018PT, shoulder pain,\u2019\u201d he said. Tendons in particular need \u201ceccentric and progressive loading,\u201d Goldman said. \u201cWe\u2019re taught if it hurts, don\u2019t do it. We say that a lot to patients about their pathologies. Tendons are the exception. You need to grit it out, because if you don\u2019t load the tendon, it\u2019s not going to repair …. Soreness is actually part of that healing process.\u201d<\/li>\n Corticosteroid<\/b>s <\/b>are \u201cuseful but limited.\u201d <\/b>Although they provide pain relief, corticosteroid injections often have inferior long-term outcomes, \u201cespecially for tendon pathology,\u201d Goldman said. \u201cFor a long, long time, we believed they were curative, [which is] not true,\u201d he added. Goldman recommended using corticosteroid injections as an adjunct to physical therapy, not as a replacement, \u201cwith the exception of frozen shoulder, specifically.\u201d<\/li>\n Early mobilization is better than immobilization.<\/b> The traditional \u201crest, ice, compression and elevation\u201d approach can be used \u201cfor a little bit,\u201d but Goldman said \u201cyou have got to get moving.\u201d For ankle sprains specifically, \u201cwe need to strengthen [and] fix the biomechanics,\u201d he said. \u201cGive them a little supportive care with an ankle brace for that first week, but then you have got to get them out and get them into rehab.\u201d<\/li>\n \u201c<\/b>Know when to escalate care.<\/b>\u201d<\/b> Goldman advised referring patients to a specialist when they are not improving with structured rehabilitation or if there is concern about structural pathology like a tendon tear. \u201cGet your advanced imaging. Feel free to refer them on for additional care,\u201d he said. \u201cI always tell my fellows, if you look at an X-ray and you freak out, just send it to somebody else. That\u2019s totally fine.\u201d<\/li>\n<\/ul>\n
Back to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nMusculoskeletal issues can typically be diagnosed on clinical exam.<\/li>\nPhysical therapy is the mainstay treatment. Corticosteroids can be used to supplement \u2014 not replace \u2014 physical therapy.<\/li>\n<\/ul>\nSAN FRANCISCO \u2014 Most musculoskeletal issues can be managed in primary care as they typically do not require complex imaging or immediate specialist referral, according to a speaker here.<\/p>\nCommon musculoskeletal conditions include lateral hip pain, anterior knee pain, ankle inversion injuries, shoulder pain, stiff shoulders and lateral elbow pain, Joshua <\/b>T. <\/b>Goldman, MD, MBA,<\/b> associate clinical professor in the division of sports medicine at the University of California, Los Angeles, told attendees at ACP\u2019s Internal Medicine Meeting.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Ankle sprains accounted for about 7% to 10% of ED visits, according to Joshua T. Goldman, MD, MBA. <\/strong>Image: Adobe Stock<\/em> \n <\/figcaption> \n <\/figure>\nUnderstanding how to diagnose and manage these conditions can potentially reduce ED overuse. For example, \u201cone ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we\u2019re trying to declutter our ERs, this is a good place to start,\u201d Goldman said.<\/p>\nHe outlined some practical tips for primary care physicians to keep in mind when approaching musculoskeletal injuries:<\/p>\n\n Most diagnoses <\/b>can be made with a <\/b>clinical<\/b> exam<\/b>.<\/b> Goldman advised primary care providers to \u201ctrust your targeted history and exam.\u201d Although imaging is a helpful adjunct, advanced imaging may show abnormalities not related to the patient\u2019s symptoms. For example, he said \u201cthere\u2019s nothing more terrifying than MRI\u2019ing the foot of a middle-aged runner. You\u2019re going to see a lot of bad stuff in there. I warn patients … it\u2019s going to look bad. Don\u2019t freak out.\u201d<\/li>\n \u201c<\/b>-i<\/b>tis<\/b>\u201d<\/b> is often a misnomer.<\/b> Many conditions are not primarily inflammatory but instead are often caused by tissue degeneration, Goldman said. For example, \u201cgreater trochanteric pain syndrome is actually gluteal tendinosis, and lateral epicondylitis is actually common extensor tendinosis,\u201d he said. \u201cWhen we start to reframe what that pathology is, the treatment starts to make more sense.\u201d<\/li>\n Biomechanics drive symptoms.<\/b> Underlying mechanical issues like muscle weakness are often the root cause of pain. Passive interventions alone cannot resolve the issue; the biomechanics need to be corrected, Goldman said.<\/li>\n \u201c<\/b>Physical therapy <\/b>is the<\/b> cornerstone of treatment.<\/b>\u201d Most patients with musculoskeletal issues benefit from physical therapy, according to Goldman. But PCPs must \u201cbe specific, be prescriptive and be targeted” in what they want the physical therapist to work on, not just \u201c\u2018PT, shoulder pain,\u2019\u201d he said. Tendons in particular need \u201ceccentric and progressive loading,\u201d Goldman said. \u201cWe\u2019re taught if it hurts, don\u2019t do it. We say that a lot to patients about their pathologies. Tendons are the exception. You need to grit it out, because if you don\u2019t load the tendon, it\u2019s not going to repair …. Soreness is actually part of that healing process.\u201d<\/li>\n Corticosteroid<\/b>s <\/b>are \u201cuseful but limited.\u201d <\/b>Although they provide pain relief, corticosteroid injections often have inferior long-term outcomes, \u201cespecially for tendon pathology,\u201d Goldman said. \u201cFor a long, long time, we believed they were curative, [which is] not true,\u201d he added. Goldman recommended using corticosteroid injections as an adjunct to physical therapy, not as a replacement, \u201cwith the exception of frozen shoulder, specifically.\u201d<\/li>\n Early mobilization is better than immobilization.<\/b> The traditional \u201crest, ice, compression and elevation\u201d approach can be used \u201cfor a little bit,\u201d but Goldman said \u201cyou have got to get moving.\u201d For ankle sprains specifically, \u201cwe need to strengthen [and] fix the biomechanics,\u201d he said. \u201cGive them a little supportive care with an ankle brace for that first week, but then you have got to get them out and get them into rehab.\u201d<\/li>\n \u201c<\/b>Know when to escalate care.<\/b>\u201d<\/b> Goldman advised referring patients to a specialist when they are not improving with structured rehabilitation or if there is concern about structural pathology like a tendon tear. \u201cGet your advanced imaging. Feel free to refer them on for additional care,\u201d he said. \u201cI always tell my fellows, if you look at an X-ray and you freak out, just send it to somebody else. That\u2019s totally fine.\u201d<\/li>\n<\/ul>\n
SAN FRANCISCO \u2014 Most musculoskeletal issues can be managed in primary care as they typically do not require complex imaging or immediate specialist referral, according to a speaker here.<\/p>\n
Common musculoskeletal conditions include lateral hip pain, anterior knee pain, ankle inversion injuries, shoulder pain, stiff shoulders and lateral elbow pain, Joshua <\/b>T. <\/b>Goldman, MD, MBA,<\/b> associate clinical professor in the division of sports medicine at the University of California, Los Angeles, told attendees at ACP\u2019s Internal Medicine Meeting.<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Ankle sprains accounted for about 7% to 10% of ED visits, according to Joshua T. Goldman, MD, MBA. <\/strong>Image: Adobe Stock<\/em> \n <\/figcaption> \n <\/figure>\nUnderstanding how to diagnose and manage these conditions can potentially reduce ED overuse. For example, \u201cone ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we\u2019re trying to declutter our ERs, this is a good place to start,\u201d Goldman said.<\/p>\nHe outlined some practical tips for primary care physicians to keep in mind when approaching musculoskeletal injuries:<\/p>\n\n Most diagnoses <\/b>can be made with a <\/b>clinical<\/b> exam<\/b>.<\/b> Goldman advised primary care providers to \u201ctrust your targeted history and exam.\u201d Although imaging is a helpful adjunct, advanced imaging may show abnormalities not related to the patient\u2019s symptoms. For example, he said \u201cthere\u2019s nothing more terrifying than MRI\u2019ing the foot of a middle-aged runner. You\u2019re going to see a lot of bad stuff in there. I warn patients … it\u2019s going to look bad. Don\u2019t freak out.\u201d<\/li>\n \u201c<\/b>-i<\/b>tis<\/b>\u201d<\/b> is often a misnomer.<\/b> Many conditions are not primarily inflammatory but instead are often caused by tissue degeneration, Goldman said. For example, \u201cgreater trochanteric pain syndrome is actually gluteal tendinosis, and lateral epicondylitis is actually common extensor tendinosis,\u201d he said. \u201cWhen we start to reframe what that pathology is, the treatment starts to make more sense.\u201d<\/li>\n Biomechanics drive symptoms.<\/b> Underlying mechanical issues like muscle weakness are often the root cause of pain. Passive interventions alone cannot resolve the issue; the biomechanics need to be corrected, Goldman said.<\/li>\n \u201c<\/b>Physical therapy <\/b>is the<\/b> cornerstone of treatment.<\/b>\u201d Most patients with musculoskeletal issues benefit from physical therapy, according to Goldman. But PCPs must \u201cbe specific, be prescriptive and be targeted” in what they want the physical therapist to work on, not just \u201c\u2018PT, shoulder pain,\u2019\u201d he said. Tendons in particular need \u201ceccentric and progressive loading,\u201d Goldman said. \u201cWe\u2019re taught if it hurts, don\u2019t do it. We say that a lot to patients about their pathologies. Tendons are the exception. You need to grit it out, because if you don\u2019t load the tendon, it\u2019s not going to repair …. Soreness is actually part of that healing process.\u201d<\/li>\n Corticosteroid<\/b>s <\/b>are \u201cuseful but limited.\u201d <\/b>Although they provide pain relief, corticosteroid injections often have inferior long-term outcomes, \u201cespecially for tendon pathology,\u201d Goldman said. \u201cFor a long, long time, we believed they were curative, [which is] not true,\u201d he added. Goldman recommended using corticosteroid injections as an adjunct to physical therapy, not as a replacement, \u201cwith the exception of frozen shoulder, specifically.\u201d<\/li>\n Early mobilization is better than immobilization.<\/b> The traditional \u201crest, ice, compression and elevation\u201d approach can be used \u201cfor a little bit,\u201d but Goldman said \u201cyou have got to get moving.\u201d For ankle sprains specifically, \u201cwe need to strengthen [and] fix the biomechanics,\u201d he said. \u201cGive them a little supportive care with an ankle brace for that first week, but then you have got to get them out and get them into rehab.\u201d<\/li>\n \u201c<\/b>Know when to escalate care.<\/b>\u201d<\/b> Goldman advised referring patients to a specialist when they are not improving with structured rehabilitation or if there is concern about structural pathology like a tendon tear. \u201cGet your advanced imaging. Feel free to refer them on for additional care,\u201d he said. \u201cI always tell my fellows, if you look at an X-ray and you freak out, just send it to somebody else. That\u2019s totally fine.\u201d<\/li>\n<\/ul>\n
Understanding how to diagnose and manage these conditions can potentially reduce ED overuse. For example, \u201cone ankle inversion injury is occurring per 10,000 people each day. Ankle sprains constitute 7% to 10% of all visits to the ED. So, if we\u2019re trying to declutter our ERs, this is a good place to start,\u201d Goldman said.<\/p>\n
He outlined some practical tips for primary care physicians to keep in mind when approaching musculoskeletal injuries:<\/p>\n