Orthopaedics is a branch of medicine related to your body's musculoskeletal system. This includes your bones, joints, ligaments, muscles, nerves and tendons. Damage to any of these can greatly affect your ability to move, work and be active.
If you get into a nasty accident and suspect suffering from a broken bone, you will likely be examined by an orthopaedic specialist. With more than 200 bones in your body, there is a high possibility of you needing to consult the expertise of a bone specialist at least once in your lifetime.
People also visit an orthopaedic specialist when they are suffering from unexpected injuries or having a chronic condition, such as arthritis or lower back pain.
Often referred to as orthopaedic surgeons, these specialists diagnose and treat conditions as well as assist you with rehabilitation so you could regain movement, strength, range of motion, and flexibility following an injury or surgery.
Orthopaedic specialists also help in developing treatment plans to help you avoid risking further injury and worsening your current condition.
Due to the vastness of the orthopaedic field, orthopaedic surgeons tend to specialise even further. Some subspecialty areas of orthopaedics include:
- foot and ankle
- hip and knee
- shoulder and elbow
- sports medicine
- trauma surgery
- paediatric orthopaedic
What types of conditions do orthopaedic specialist doctors treat?
Orthopaedic doctors treat a wide variety of conditions, including but not limited to the following:
- joint arthritis
- bone cancer
- bone fractures/joint dislocation
- carpal tunnel syndrome/trigger fingers
- injuries to tendons or ligaments, such as sprains, tendonitis and ACL tears
- joint or back pain
- limb abnormalities such as clubfoot and bowlegs
- muscle strains
Nonsurgical orthopaedic treatments
In some cases, orthopaedic specialists may recommend non-surgical procedures first, before proposing surgery. These forms of treatment are also called conservative treatments.
Some types of nonsurgical treatments include:
- Exercises – Orthopaedic specialists may suggest certain stretching or mobility exercises that can help in maintaining or improving your strength, flexibility, and the range of motion at problematic areas.
- Immobilisation – Should an injured limb be under excessive stress; the advice may be to avoid putting additional strain on the affected area so that it will have a chance to heal. This also includes providing extra support to the affected areas. Examples of immobilisation methods are braces, splints and casts.
- Medications – To relieve symptoms of pain and swelling, your orthopaedic specialists may suggest over-the-counter medication or certain prescription drugs, depending on the severity.
- Lifestyle changes – Lifestyle changes are necessary in order to avoid further injury and halt your condition from getting worse. Orthopaedic specialists may help in altering your diet, ways to exercise and advice you on the limits of physical activity.
Surgical orthopaedic treatments
There are times when the condition or injury does not improve, even after preventive measures have been taken. In these cases, surgery may be needed. Some examples of operations performed by an orthopaedic surgeon include:
- Fusion – Involves using bone graft material (autograft, allograft, or artificial bone substitutes) to connect two bones and allow them to be together. It is commonly used in neck and spine surgery.
- Internal fixation – Bone fragments are relocated according to their usual placement and held together using special implants such as nails, plates, screws and wires.
- Joint replacement – A surgical procedure that involves replacing the parts of a joint that have become damaged, with a prosthesis. Common examples include knee replacement and hip replacement surgery. It can also be done on other joints as well such as ankle, elbow, shoulder and wrist.
- Osteotomy – A type of surgery that involves cutting a part of a bone (either tibia or femur) and then repositioning it to relieve pressure on the knee joint. This type of surgery may sometimes be used to treat arthritis.
- Release surgery – A type of surgery that is performed to treat carpal tunnel syndrome. The surgery helps to relieve symptoms by reducing pressure on the median nerve.
- Soft tissue repair – A type of surgery to repair severely damaged muscles, ligaments, or tendons due to an injury.
- Reconstruction of torn ligament, e.g. ACL reconstruction and other ligaments
Myths and Misconceptions in Orthopaedics Surgery
Myth: “If you can walk on it then it’s not broken”
There is a common misconception that if a person has damaged her lower extremity and is able to stand and walk on her own, she does not have a fracture or a significant structural injury. However, it should be noted that fractures of non-weight-bearing bones of the lower extremity, such as the fibula, patella, phalanges, etc., typically allow walking with slight discomfort.
Ligament tears, small joint dislocations, muscle tears and other conditions are also compatible with ambulation. As a result, if there has been serious damage, a comprehensive evaluation should be performed to rule out a major injury.
Myth: “Cracking your knuckles causes arthritis”
Cracking knuckles, particularly by children, is thought to cause early joint pains, swelling, joint stiffness, and arthritis. According to various studies, cracking your knuckles does not increase your chance of developing arthritis. The pop sound is caused by nitrogen bubbles popping within the fluid that lubricates your joints.
The popping sound can also be caused by ligament movement. When you stretch or bend your fingers backward, you are pulling your bones apart, putting negative pressure on them. Having said that, cracking your knuckles may lead to reduced grip strength. If you experience some discomfort when cracking your knuckles, you should consult a doctor.
Myth: “Sour foods or dairy products can cause arthritis to get worse”
Traditional medicine advocates caution against consuming sour substances and dairy products if you have arthritis. That is simply not true. Any food or drink that enters the body is neutralised as soon as it reaches the stomach. The study of arthritis has now progressed significantly and it does not mention of certain foods influencing the progression of the aforementioned disease. In reality, the Vitamin C found in citrus foods is needed for the production of collagen, a necessary component of bones and other tissues, and can aid in the relief of arthritis symptoms.
Likewise, milk is a good source of calcium and milk products are good sources of proteins, which are often lacking in arthritis patients. As a result, these patients should be recommended to consume adequate amounts of the above foods. While data on vitamins and micronutrients is limited, these nutrients can play a role in preventing and slowing the progress of osteoarthritis.
Myth: “Never wear high heels”
High heels are often associated with being bad for the foot and comfort. There is also a tendency among physicians to attribute all chronic lower-limb disorders to them, regardless of direct evidence to the contrary.
Studies has shown that continuous and extended use of high heels for several years has detrimental effects on the back, hips, knees, ankles, and feet. However, according to an advanced research in South Korea, it suggests that wearing high heels can actually strengthen your ankle muscles during the first three years, but prolonged used (more than four years) can cause a muscular imbalance.
As a result, a safer recommendation would be to wear less than 3-inch heels and vary the heel height as much as possible. For instance, wear high heels one day and flat heels the next. Since people's feet differ in their neutral positions and ranges of motion, the safe height of heels varies as well.
When should you visit an orthopaedic doctor?
You may need to see an orthopaedic doctor if you:
- Have decreased mobility or range of motion in your elbow, knee or shoulder
- Suffer from an injury to a bone or joint
- Experience frequent nerve-related symptoms, such as numbness and tingling or a feeling of “pins and needles” in either your arms or legs
- Pain or swelling in a bone, joint, or muscle that is persistent and does not respond to at-home care
- Find difficulty in performing your day-to-day tasks due to excessive pain in the joints
Find the best orthopaedic surgeons at Parkcity Medical Centre (PMC). Our team of outstanding orthopaedic professionals provide high-quality treatment for a wide variety of orthopaedic conditions. Our highly experienced orthopaedic surgeons provide first-rate surgery covering a wide variety of operations, such as hip and knee replacements, shoulder injuries and spinal surgery, as well as providing excellent clinical services for the treatment of sports injuries.
General Orthopaedics – Common bone disorders
General orthopaedics is a surgical speciality that focuses on the treatment of musculoskeletal injuries and diseases. It is a complex system – which consists of your ligaments, joints, bones, tendons, muscles and nerves – that enables you to move, work and be active.
However, among the many disorders that fall under the specialty, there are some orthopaedic conditions that are more common than others, affecting a huge number of individuals around the world.
Some of the risk factors that contribute to how these diseases are unavoidable such as age, gender and family history. Additionally, poor lifestyle choices also have significantly contributed to the prevalence of these diseases.
Here are some examples of common orthopaedic disorders.
Arthritis and other rheumatic diseases are common orthopaedic disorders that cause pain, stiffness or swelling in the joints, muscles, tendons, ligaments, or bones. This thus results in reduced mobility. These diseases can also affect the body's connective tissues.
There are over a hundred different types of arthritis, and it is commonly a chronic condition. Patients with arthritis will often discover redness and swelling (inflammation) around their joint area (the point at which two or more bones meet).
People of all ages can be affected by arthritis. However, it is more prevalent in women than men. While there is no known cure for arthritis, the aim of treatment is to reduce pain and inflammation while preserving joint function. Treatment for arthritis include medication, weight loss, exercise and surgery.
Your body replaces the components of your bones on a regular basis. Osteoporosis occurs when certain components are depleted too quickly or are not replenished quickly enough or both. According to recent statistics from the International Osteoporosis Foundation, worldwide, one in every three women over the age of 50 years and one in every five men will experience osteoporotic fractures in their lifetime.
Osteoporosis is often regarded as “the silent disease”. There are usually no visible signs in the early stages of bone loss and people with osteoporosis will not feel any different from years prior. However, once your bones have been weakened by osteoporosis, you may experience symptoms such as back pain (caused by a fractured or collapsed vertebra), loss of height over time, a stooped posture and a bone that breaks much more easily than expected.
Fortunately, osteoporosis is preventable. A good diet and regular exercise are important for maintaining bone health throughout your life. Limiting alcohol intake and stop smoking can also help in protecting your skeleton.
At ParkCity Medical Centre (PMC), we provide a high-quality care for a wide range of orthopaedic conditions with the help of our exceptional team of orthopaedic specialists. Our highly trained orthopaedic surgeons provide first-rate surgical intervention for a wide range of procedures as well as excellent clinical services.
Sports injuries can occur when you are exercising or playing sports and it can happen to anyone, be it children or adults. However, you’re more likely to be at risk of sports injuries if you haven’t been regularly active, fail to warm up properly before exercise or play contact sports.
Types of common sports injuries
Different sports injuries may show different symptoms and complications. Here are the most common types of sports injuries:
Achilles tendon rupture – The Achilles tendon is a powerful, thin tendon located at the back of your ankle. This tendon can rupture or break during sports. When this happens, you may feel intense pain and have trouble walking.
ACL tear - The ACL, or anterior cruciate ligament, joins the leg bone to the knee. The act of abruptly halting and changing directions, or a severe collision to the side of the knee, can result in an ACL strain or tear. A totally torn ligament needs surgery and may end an athlete's athletic career.
Dislocations – High intensity or contact sports can cause a bone in your body to dislocate. When this occurs, a bone is pushed out of its socket. This can be excruciatingly painful, resulting in swelling and weakness in the limb
Fractures – Broken bones are another term for bone fractures.
Knee injuries – A sports injury is described as any injury that interferes with the movement of the knee joint. It may be anything from an overstretch to a tear in the knee's muscles or tissues.
Meniscus tear - Any activity that causes you to abruptly twist or rotate your knee, especially when you put your entire weight on it, might result in a torn meniscus.
Rotator cuff injury – The rotator cuff is made up of four muscles that surround the shoulder area. The rotator cuff ensures that the arm moves in all directions. A tear in any of these muscles will cause the rotator cuff to weaken.
Sprains – A sprain occurs when the ligaments are overstretched or torn. Ligaments are tissue pieces that link two bones in a joint.
Strains – These are caused by overstretching or tearing of muscles or tendons. Tendons are fibrous tissue cords that link bone to muscle. It’s common for it to be mistaken as sprains sometimes.
Swollen muscles – Swelling is a normal response to an injury. Swollen muscle can also be painful and weak.
Self-treatment: Follow PRICE
If you are treating the injury by yourself, be sure to follow PRICE: Protection, Rest, Ice, Compression, and Elevation.
PROTECT - Injured tissues must be protected from further damage. Apply bandages, elastic bands or clear splints to protect minor injuries. Anything as simple as taping an injured toe to the next stable toe can sometimes suffice. However, consult your doctor if you have a condition that necessitates the use of precision splints or casts.
REST - Tissues that have been injured need time to recover. It's a simple idea, but once you're hooked on exercise, you might be inclined to disregard the need for appropriate rest. You may decide to rest selectively or decide to continue pushing yourself for a more intense workout or continue exercising as you fail to realise the strain on your body. Unfortunately, it will be too late once your muscles or tendons are injured.
Should this happen, you will have to stop playing your favourite sports while your injured ligaments, muscles and tendons recovers. In cases such as tendinitis, you will still be able to walk, jog or climb. In a strange way, an accident may be a blessing in disguise because it forces you to diversify your workouts and learn new skills.
ICE - It's the easiest, quickest, and most reliable way to treat many injuries. Ice works well as an anti-inflammatory, reducing swelling and discomfort. Apply an ice pack for 10 to 15 minutes as soon as possible after an injury for the best results. For the first four hours, repeat the ice treatment every hour, then four times a day for the next two or three days. Use a thin cloth to protect your skin to avoid it becoming raw, blistered or numb. Switch to heat treatments after 48 to 72 hours, following the same plan and principles.
COMPRESSION - Pressure will help in the reduction of swelling and inflammation. A simple elastic bandage would suffice in most cases; it should be snug but not too tight. Remember that swelling will appear hours after an injury, so you may need to loosen your brace. Another technique is to apply a small piece of foam rubber directly to the wounded area before wrapping it; this allows you to apply gentle pressure where it's required without constricting an entire joint or limb.
ELEVATION - It's a straightforward technique that uses gravity to drain fluid away from damaged tissues, reducing swelling and inflammation as well as pain. Elevating a sore foot or other limb on a hassock or putting a pillow under it in bed can help you heal faster.
Call your orthopaedic doctor
Seek medical attention immediately if the problem is in the same area as a prior injury. If you do not see any improvement after 24 to 36 hours of PRICE, consult your doctor.
The bones of children are weaker than those of an adult because the skeleton has not completely developed. Take extra care when dealing with a child's sports injuries. What seems to be a tissue injury may be a more severe fracture.
Don't dismiss the symptoms. Remember, the sooner you receive a diagnosis and treatment, the sooner you can recover and return to play
At Parkcity Medical Centre (PMC), our outstanding team of orthopaedic specialists offers high-quality treatment for a wide variety of orthopaedic conditions. Our highly skilled orthopaedic surgeons provide first-rate surgical intervention for a wide range of procedures including hip and knee replacements, shoulder injuries and spinal surgery as well as excellent clinical services for the treatment of sports injuries.
Hip & Knee Replacement
Hip and knee replacement are two of the most popular orthopaedic surgeries performed. This is particularly among the older generation, who live with osteoarthritis and have weakened bones in the hips and knees. Both procedures are extremely effective at relieving discomfort, correcting deformity and enhancing patient mobility, allowing patients to regain their quality of life and return to their daily activities.
When should hip and knee replacement be recommended?
A variety of conditions can result in a reduced range of motion in your hip and knee, such as osteoarthritis and rheumatoid arthritis. Joint pain is often caused by damage to the cartilage that lines the ends of the bones (articular cartilage) caused by an arthritis, a fracture or another disease. It is this sharp pain that prompts patients to seek medical treatment.
If nonsurgical treatments such as medications, physical therapy and lifestyle changes do not alleviate your pain and discomfort, your doctor may suggest total joint replacement.
What happens during hip and knee replacement surgery?
In cases requiring hip replacement, the damaged ball and socket joint is removed and replaced with either a metal or ceramic ball. This ball is connected to a stem that fits into the femur (thigh bone). The prosthesis is normally covered with a specific material into which the bone can develop over time.
However, in some cases, the prosthesis is cemented into the bone. The socket part of the ball and socket joint is also replaced by a metal cup that is inserted into the pelvis. After that, a plastic liner is snapped into the metal cup and rotates with the new ball at the end of the femoral stem. Prostheses and implants are available in a variety of shapes and sizes that can be customised according to the patient.
In knee replacement surgery, a thin layer of bone is removed from the end of the femur or thigh bone, the top of the tibia or leg bone, and the underside of the kneecap. The bone surfaces are then moulded and sized with tools to allow for an optimal implant fit for each individual knee.
The major ligaments and tendons of the knee are usually held in place to provide support and regular motion of the knee joint. Knee replacements, like hip replacements, may be cemented in place or covered in a special material into which bone can develop.
Your orthopaedic specialist will discuss the possible risks and complications of hip and knee replacement surgery, including those linked to the surgery itself and those that may arise over time following the surgery.
Complications that may arise during or post-surgery include infection, blood clots, nerve damage, and prosthesis issues such as loosening or dislocation. However, such complications are not common.
Each patient’s recovery and rehabilitation is unique. In most cases, your doctor will advise you to start using your "new" joint as soon as possible after surgery.
Most patients will experience some temporary pain in the replaced joint as the surrounding muscles are weak from inactivity. The body is also adjusting to the new joint and the tissues are healing. This pain should resolve in a few months.
Exercise is a key element of the healing process. The doctor or physical therapist may recommend specific exercises to help restore mobility and stabilise the joint.
If you have any questions about movement limits after hip or knee replacement surgery, please consult your doctor.
After joint replacement surgery, the majority of patients are able to enjoy everyday tasks with greater ease. Most people can expect their joint replacement to last for several years, providing them with a higher quality of life, including reduced pain and increased motion and strength that would not have been possible otherwise.
At Parkcity Medical Centre (PMC), our team of exceptional orthopaedic specialists provide high-quality care for a large range of orthopaedic conditions. Our highly experienced orthopaedic surgeons provide first-rate surgical intervention covering a large number of procedures such as hip and knee replacements, shoulder injuries and spinal surgery, as well as offering exceptional clinical care for the treatment of sporting injuries.
What is minimally invasive interventional spine treatment?
Our specialists specialise in the diagnosis and treatment of acute back and neck pain and injuries, specifically when it comes to minimally invasive interventional spine treatment. More than 90% of spine cases are resolved through non-operative treatment. Our spine doctors use the following interventional spine procedures to diagnose and treat painful spine conditions.
- Epidural steroid injections
- Nerve root injections
- Facet joint injections
- Medial branch block
- Intradiskal electrothermal therapy (IDET)
- Sacroiliac (SI) joint injections
- Radiofrequency lesioning (RF)
Interventional spine medicine utilises minimally invasive procedures and special imaging technology to not only pinpoint the location of the pain, but treat it right at its source. In many cases, this allows the patient to go for a more conservative route and avoid surgery altogether.
In some circumstances, however, surgery cannot be avoided. Traditionally, spine surgery was done as an “open surgery,” meaning a long incision was required. With interventional spine medicine, surgery can be performed using a much smaller incision, causing less damage to the surrounding muscles and ligaments. The benefits of this type of surgery include:
- Less pain
- Faster recovery
- Less risk of infection
- Less risk of complication
- Less blood loss
- Less reliance on post-operative pain medication
Minimally invasive interventional spine treatment has grown in importance during the past several years.
Diagnostic and Therapeutic Spinal Injections
Selective spinal injections are being performed with increasing frequency in the management of acute and chronic pain syndromes. A few of the most common indications for these diagnostic and therapeutic spinal procedures are noted as follows:
- Spinal nerve radiculopathy;
- Spinal stenosis;
- Discogenic pain (i.e., symptomatic, internal disc disruption);
- Contained, disc bulge, or protrusion vs. extruded or sequestered herniated disc;
- Multilevel degenerative disc disease;
- Facet joint arthropathy or associated facet joint nerve pain;
- Sacroiliac joint pain dysfunction;
- Failed back surgery syndrome (FBSS);
- Epidural and/or perineural fibrosis/granulation with associated symptomatic pain;
- Complex regional pain syndrome (CRPS) (formerly known as reflex sympathetic dystrophy, RSD).
Most commonly done are:
- Epidural steroid injections (translaminar, transforaminal, caudal);
- Facet joint nerve blocks and facet joint intra-articular injections;
- Neurolytic and radiofrequency (RF) nerve ablation procedures;
- Sacroiliac joint and other intra-articular joint injections;
- Sympathetic ganglion nerve blocks;
- Diagnostic discographic injections;
In recent years, there has been a movement to perform more and more procedures under ultrasound guidance. Retroperitoneal masses, pleural-based masses, deep masses in the liver, and musculoskeletal masses that were once typically biopsied under CT guidance or in open surgical biopsies are now being successfully performed using ultrasound guidance
The main advantage of using ultrasound for guidance is to have continuous real-time visualisation of the biopsy needle, which allows adjustment of the needle as needed during the procedure. As the biopsy specimen is being obtained, the needle tip can be watched in real-time to ensure that it does not slip outside the mass
The Benefits of Ultrasound-Guided Injections
Ultrasound, also known as sonography, is an imaging method that uses high-frequency sound waves to produce real-time and dynamic images of the body. Ultrasound is increasingly being used to assist Sports Medicine Physicians, Rheumatologists, Orthopaedists, and Primary Care Physicians in performing evaluations and injections of different muscles, tendons, ligaments and joints.
With the advancement of this technology, ultrasound machines have become smaller and more portable. This has allowed treating clinicians to be able to use real time, point of care ultrasound, to assist in the diagnosis and treatment of their patients. Although ultrasound is frequently used to identify injuries or abnormalities; it is also used when performing injections into the knee, shoulder and hip.
Injections can be beneficial for both the diagnostic and therapeutic treatment of a variety of problems involving the hip, shoulder, and knee. Typical problems include osteoarthritis, rheumatoid arthritis, labral tears, muscle tears, ligament tears and tendinopathies.
Injections have been used in the management of inflammatory and degenerative conditions when rest, ice and anti-inflammatory medications fail to provide adequate relief. The use of ultrasound improves the accuracy of the injection of corticosteroids, hyaluronic acid or other therapies such as Platelet Rich Plasma, Prolotherapy or Stem Cells.
Ultrasound can also be used for joint aspirations to rule out joint infection or gout. Lastly, guided injections can be used diagnostically to help determine which structures are generating the patient’s pain.
Ultrasound-guided injections allow the practitioner to visualise the needle in real time as it enters the body and traverses to the desired location. This assures that the medication is accurately injected at the intended site. Despite good intentions, even in the most experienced hands, blind (injections performed without imaging) injections are not 100% accurate and in some joints accuracy is as low as 30%-40%.
With ultrasound guidance, the accuracy of nearly every joint injection exceeds 90% and approaches 100% in many. Additionally, ultrasound guided injections have been shown to be less painful than blind injections.
Ultrasound injections also have the advantage of giving “real time” and “dynamic” feedback that the patient and the doctor can see and use immediately. The doctor is able to watch the desired treatment being delivered to the intended target and even visualise surrounding structures both before during and even after the procedure.
Although there are many different types of imaging that can be used to assist with injections, ultrasound has a few distinct advantages.
Ultrasound has no radiation. Fluoroscopy (a type of real time X-ray) allows the provider to easily visualise the joint making injections easier, however, fluoroscopy is associated with repeated doses of radiation. Additionally, with fluoroscopy, the providers are unable to visualise surrounding soft tissue structures including tendon, blood vessels or nerves that may be in the path of the needle. This could lead to increased pain or other complications from the injection.
Ultrasound allows us to visualise the bony joint as well as all of the surrounding structures. Moving the ultrasound probe, the practitioner can visualise what may be in the path of the needle and avoid any unwanted complications before they happen.
Ultrasound is able to identify fluid better than conventional radiographs and can see fluid that may have accumulated in and around joints, tendons, muscles, nerves and other soft-tissue structures. CT-guided (or CAT Scan) injections are also frequently used to assist in delivering treatments. With the CT, we are able to get a 3D view of the joint to be injected and can accurately deliver the intended medication, however, these tests come with an increasingly large dose of radiation, they are expensive and time-consuming. Ultrasound injections have been shown to be as accurate as these other imaging-modalities with less cost, improved soft tissue visualisation and without the associated radiation.
Ultrasound-guided injections have been extensively studied and have been found to have very few complications.
The risks associated with these procedures are the same as any type of injection: incomplete reduction of pain, bleeding, damage to surrounding structures and infection. The overall risks for injections are very low and the use of ultrasound guidance may further reduce some of these risks
Ultrasound is beneficial when performing injections in the knee, shoulder and hip; as well as many other structures throughout the body.
At ParkCity Medical Centre, our exceptional team of orthopaedic specialists offers high-quality care for a wide range of orthopaedic conditions, eve when it comes to niche areas such as minimally invasive interventional spine treatment. Our highly skilled orthopaedic surgeons are sure to provide you first-rate surgical intervention with a lot of care.