As any bone specialist will be aware, at birth, a human child has around 270 individual bones. However, as the result of several of these becoming fused together during growth, that number decreases to just 206 upon reaching adulthood. As well as providing a framework with which to protect many of the body’s most vital organs and supporting the muscles and jointed appendages that make its many complex movements possible, some of our bones also have less obvious but equally important functions. The long bones, for example, are essential to the production of blood cells and in the storage and release of fats and minerals.
Bone specialists of various types devote their working hours to the care of the musculoskeletal system. Although they may do so in rather different ways, they all have much the same goal – to restore their patients’ health. While certain of these healthcare professionals may hold a medical degree, others do not. However, each is required to have gained a recognised qualification in his or her particular related field and all are bound by the regulations of their respective governing bodies.
In the medically qualified category, there are two types of doctor who share the responsibility for the diagnosis and treatment of the various conditions that may adversely affect components of the musculoskeletal system. While both of these bone specialists will regularly make use of non-surgical procedures such as physiotherapy and medication to treat their patients, only those who have qualified in orthopaedics are in a position to offer them the option of surgical intervention.
Often, those who find themselves under the care of an orthopaedic surgeon will have been the victim of a traumatic incident. It might have been a motor accident, a fall, or a sports injury in which there has been damage to one or more bones. While simple fractures can normally be reduced and immobilised very effectively by the emergency room staff, when the break is more complex, repairs to the affected bone will require a specialist orthopaedic surgeon. This may involve the use of special screws and nails or even the insertion of an intramedullary rod into the central core of the broken bone in order to ensure a stable union.
Though requiring extensive skill and experience, this type of procedure has long since become a relatively routine chore for the orthopaedic surgeon. In practice, many of them now regularly undertake the more challenging task of replacing the components of a joint that has become damaged beyond repair with man-made substitutes. A joint replacement may be total or partial and is most often performed on the hip, knee or shoulder. Surgical intervention by these bone specialists is most commonly required by those patients who present with a swollen and painful joint that is subsequently found to be the result of osteoarthritis. While prescription painkillers and steroids will normally provide relief for several years, the condition is a progressive one and so, at some point, a joint replacement will become the only effective option.
Sometimes, however, multiple joints may be affected simultaneously, and a surgical solution is unlikely to be either practical or effective. In contrast to the localised pain and swelling seen in osteoarthritis, these more widespread symptoms, often accompanied by a rash, fever or general fatigue, call for the expertise of the second variety of medically-qualified bone specialists – the rheumatologist. While there is a degree of overlap between the two professions, much of a rheumatologist’s time is devoted to patients with autoimmune disorders, some of these fall under the heading of rheumatic diseases, which explains the name given to this discipline of medicine.
These conditions produce inflammation of the body’s connecting and supporting structures. Principally, it is the joints that are affected, but sometimes bones and the associated muscles, tendons and ligaments are also involved. There are more than a hundred rheumatic diseases of which some of the most commonly treated by these bone specialists are gout, rheumatoid arthritis and fibromyalgia. Like their orthopaedic colleagues, rheumatologists will often rely on X-rays, medical imaging technology and lab test to confirm a diagnosis but, to treat their patients, they rely on medication such as oral or systemic analgesics and non-steroidal anti-inflammatory agents, or a suitable immuno-suppressant agent. Where surgery may appear to be necessary, the rheumatologist will arrange a referral with an orthopaedic surgeon.
If you wish to learn more about this specialised field or wish to make an appointment with Dr Jan de Vos, contact us at 012 807 0335 or send an email to admin@drdevos.co.za.