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Orthopaedics is a medical specialty concerned with the diagnosis, care and treatment of patients with musculoskeletal disorders. The physicians who specialize in treating injuries and diseases of the musculoskeletal system are called orthopaedic surgeons or orthopaedists. Orthopaedists treat a wide variety of diseases and conditions, including such common injuries as fractures, torn ligaments, dislocations, sprains, tendon injuries, pulled muscles, and ruptured discs. They also treat conditions such as low back pain, sciatica, knock knees or bow legs, bunions, and hammer toes.

A pediatric orthopaedist is the best-trained and most experienced doctor to properly evaluate and treat musculoskeletal (bone, joint, or muscle) problems in a child who is still growing. This includes newborn babies through teenagers. Pediatric orthopaedic surgeons choose to make the care of children the focus of their medical practice. The unique nature of medical and surgical care of children is learned from advanced training and experience in practice. They are doctors who have: Graduated from an approved medical school (typically four years); Graduated from an approved orthopaedic surgery residency program (typically five years); Completed additional subspecialty training in pediatric orthopaedics and pediatric spinal deformity (typically one year).

A child’s musculoskeletal problems are different from those of an adult. Because children are still growing, the body’s response to injuries, infections, and deformities may be quite different than what would be seen in a full-grown person. Sometimes, what is thought to be a problem in a child is just a variation of growth that will resolve with time. A good example of this is in toeing in a toddler. Some of the problems children have with their bones and joints that are due to growth do not even occur in adults. And, the evaluation and treatment of a child is usually quite different than for an adult — even for the same problem. Children with complex pediatric problems are best managed by a medical­ surgical team approach. Pediatric orthopaedic surgeons diagnose, treat, and manage children’s musculoskeletal problems.

Pediatric orthopaedists have the widest range of treatment options, the most extensive and comprehensive training, and the greatest expertise in dealing with children and treating their musculoskeletal problems. Your Pediatrician or primary care doctor may have suggestions about whom to see, or if you feel that a pediatric orthopaedist is the right doctor for your child, the Pediatric Orthopaedic Society of North America (POSNA) website (www.posna.org) contains a directory of members in every geographic location.

The rotator cuff is a large tendon comprised of four muscles which combine to form a “cuff” over the upper end of the arm, the head of the humerus. The four muscles-supraspinatus, infraspinatus, subscapularis and teres minor- originate from the “wing bone,” the scapula, and together form a single tendon unit that inserts on the greater tuberosity of the humerus. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint.

A rotator cuff tear may result from an acute injury such as a fall or may be caused by chronic wear and tear with degeneration of the tendon. Impingement of the front of the scapula, the acromion, on the tendon is believed to be a major cause of cuff tears in individuals older than 40 years. Typically, you will feel pain in the front of your shoulder that radiates down the side of your arm. It may be present with overhead activities such as lifting or reaching. You may feel pain when you try to sleep on the affected side. You may note weakness of your arm and difficulty with routine activities such as combing your hair or reaching behind your back. If the tear occurs with injury, you may experience acute pain, a snapping sensation, and immediate weakness of the arm.

If you have injured your shoulder or have chronic shoulder and arm pain, it is best to see your orthopaedic surgeon. He or she can then make a diagnosis and begin treatment. The doctor may recommend a diagnostic study such as MRI (magnetic resonance imaging) to confirm the diagnosis. Early diagnosis and treatment of a rotator cuff tear may prevent symptoms such as a loss of strength and loss of motion from setting in. If your primary physician has already made the diagnosis, an orthopaedic surgeon can review both surgical and nonsurgical options and start treatment.

There are numerous causes for back pain ranging from muscle strain, trauma, arthritis, disc herniation, muscle spasm, facet joint pain, and cumulative effect of poor body mechanics.

When the disc bulges or herniates into the spinal canal, the nerves in that area can become inflamed or agitated, creating both back pain and pain in the area where that nerve carries impulses. The muscles surrounding the injured disc can become fatigued and spasm.

A bulging disc is a slight protrusion of the center of the disc (nucleus pulposus) into the spinal canal. In the bulging disc, the annulus fibrosus (outer ring) has not been ruptured. A disc herniation is a large protrusion of the nucleus pulposus (center of the disc), which has burst through the annulus fiborsus (outer ring of the disc) into the spinal canal, invading the surrounding nerves and causing pain in the back, buttocks, hips, or legs.

A herniated disc is treated with conservative therapy unless there is a spinal deformity or neurological defect. Conservative therapy can include physical therapy, chiropractic care, acupuncture, Pilate’s, ultrasound, pain medication, muscle relaxants, and short course of steroids. If these do not work, the next steps include a steroid epidural or facet joint block. Surgical intervention is the last resort. If surgical intervention becomes necessary, a microdiscectomy is the most common procedure.

The most common causes of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.

Whether to have hip replacement surgery should be a cooperative decision made by you, your family, your primary care doctor, and your orthopaedic surgeon. The process of making this decision typically begins with a referral by your doctor to an orthopaedic surgeon for an initial evaluation. Although many patients who undergo hip replacement surgery are 60 to 80 years of age, orthopaedic surgeons evaluate patients individually. Recommendations for surgery are based on the extent of your pain, disability, and general health status-not solely on age. Your orthopaedic surgeon will review the results of your evaluation and discuss whether hip replacement surgery is the best method to relieve your pain and improve your mobility.

Sometimes it’s tough to tell, even for the doctors. When you tear your ACL, it feels a lot “looser” than your good knee. It almost feels like it could pop out of place at any minute. The stability just isn’t there. When some people tear their ACL, they hear a “pop” when it happens. It’s usually pretty loud and noticeable. If you have a torn ACL it also usually swells up immediately…the pain isn’t always severe, but swelling is a tell-tale sign.

There are several things that will affect this answer. Do you plan on playing sports or are you happy giving them up and doing things less stressful on the knees? If you can give up the sports that are rough on the knees, you might get by without surgery. Does your knee “go out” a lot? If it does and you have little control over it, surgery would probably be your best option.

Everyone recovers at a different rate. The most standard answer that you will hear from the doctor is six months. It’s possible to return sooner than six months, but the risks for re-injury are higher. It takes about 12-18 months for your new ACL to be in peak condition. At six months, it’s about 80-85%.

Scoliosis is a common condition that affects many children and adolescents. Simply defined, scoliosis is a sideways curve of the spine. Instead of a straight line down the middle of the back, a spine with scoliosis curves, sometimes looking like the letter “C” or “S.” There are several different types of scoliosis that affect children. By far, the most common type of scoliosis is “idiopathic,” which means the exact cause is not known.

In planning your child’s treatment, your doctor will take into account how severe your child’s curve is and where it occurs in the spine. Your child’s age is also an important factor–if your child’s spine is still growing, it will affect treatment choices. Your doctor will determine treatment options to meet your child’s specific needs. Most scoliosis surgeons agree that children who have very severe curves (50 degrees and higher) will need surgery to lessen the curve and prevent it from getting worse.