When referring to those healthcare professionals who devote their working day to caring for patients with disorders of the musculoskeletal system, it is worth bearing in mind that there is more than one type of practitioner who might justifiably be described as a bone specialist. Consequently, if you should develop a problem that affects some component of this system, you will need to be sure which of these various healthcare professionals’ services might be most appropriate to the treatment of that problem.
Let us say, for example, that you are a keen athlete and have experienced a severe sprain, a torn ligament, or you are showing signs of developing a tennis elbow. Clearly, conditions such as these are not going to require any form of surgical intervention. Instead, they can be treated by the less radical measures commonly adopted by a physiotherapist or a sports doctor, each of whom, in his or her own fashion, can be considered as a type of bone specialist, even though these particular injuries only affect the related soft tissues.
Any pain affecting the bones of a joint or one of the ligaments, muscles, or tendons associated with it should be considered cause for concern and justifies a visit to the relevant professional. However, whether that individual should be a rheumatologist, an osteopath, or an orthopaedic surgeon will depend upon whatever injury or illness may prove to be responsible for the pain. This is often not clear and even an experienced GP may sometimes make an inappropriate referral, leaving the chosen bone specialist to rectify the decision.
The clue to the underlying pathology is often to be found in the distribution of pain. Where it is not isolated within a particular joint but is more generalised, involving multiple joints, the cause is likely to be systemic in origin and could possibly be due to an autoimmune condition such as lupus erythematosus, fibromyalgia, scleroderma, or rheumatoid arthritis. These conditions all tend to be associated with joint pain, inflammation, muscular weakness, and chronic fatigue, and are among the many maladies routinely treated by the type of bone specialist known as a rheumatologist. Other conditions that also fall within the purview of the rheumatologist are gout, osteoporosis, back pain, myositis, vasculitis, and tendonitis, to name just a few.
That said, back pain can often be dealt with by the physical means adopted by an osteopath and which, to some extent, are similar to those adopted by a physiotherapist. In this case, however, the practitioner tends to rely mainly on the use of his or her hands, in conjunction with the patient’s symptoms, general health, and history to arrive at a diagnosis. Should it prove necessary, however, this type of bone specialist may also need to request blood tests and medical imaging procedures, or to refer a patient to a GP to corroborate his or her findings.
In addition to minor soft tissue injuries like sprains and strains, the limbs are also prone to fractures. Whether these are clean breaks or more complex in nature, repairing them is the business of an orthopaedic doctor. In the case of a simple fracture, reduction and splinting, or immobilisation with a plaster cast will normally be sufficient. However, to treat the more severe cases will often require a bone specialist with surgical skills. In such cases, it may be necessary for an orthopaedic surgeon to employ screws, nails, and intramedullary rods to ensure a sufficiently stable repair.
While such procedures can be demanding enough, they are certainly not the ultimate test of the orthopaedic surgeon’s skill. Today, many of them now devote the bulk of their theatre time to performing joint replacements. The ability to replace a badly worn joint with a prosthesis is, beyond the shadow of a doubt, the greatest achievement of those bone specialists who have chosen to practice orthopaedics.