Ortopedics is a surgical specialty that is specifically devoted to the diagnosis and treatment of the injuries of the musculoskeletal system, congenital malformations, and different diseases and the resulting deformations. Below, we introduce you to the most common orthopedic problems – joint diseases, back problems, traumas, overload-related injuries, and leg-related complaints – alongside with treatment options.
A joint disease may lead to inflammation and an increase in the amount of fluid in the joint cavity. This causes joint pain and reduces the extent of movement. If indicated, a joint can be punctured to remove excessive fluid from the joint cavity. This treatment method can be combined with an intraarticular injection to administer medicine into the joint cavity (sometimes even during the same procedure).
Most of the problems with the shoulder joint are caused by injuries to the surrounding tendons, ligaments and bursae. This may lead to inflammation of a tendon (tendonitis) or a rupture. Causal mechanisms leading to an injury include muscle atrophy (wasting away of a muscle), underuse of muscles, overload and trauma.
In elderly people, the most common problem related to the musculoskeletal system is knee pain. Usually it results from osteoarthritis caused by the breakdown of joint cartilage. In case of arthritis, the whole joint is damaged and inflamed. Osteoarthritis of the knee joint is characterized by the breakdown of the cartilage of the knee joint, which induces changes in surrounding tissues as well. In the early phases of the disease, conservative treatment (various medications, including painkillers, combined with physiotherapy) is used. However, in case of serious damage, knee arthroplasty is used. This is a surgical procedure whereby the damaged knee joint is replaced by an artificial joint.
Arthritis can affect the hip joint as well and its treatment tactics is similar to the knee joint. In addition to artrhitis, hip arthroplasty is also indicated in case of a hip fracture caused by a fall.
However, problems with the hip joint affect not only grown ups. Hip joint dysplasia is one of the most frequent congenital defects. In this condition, the hip joint has not fully developed and the socket portion does not fully cover the ball portion. The earlier the disease is discovered, the faster and more effective is the treatment. For that reason, all newborns are screened for this disease.
About four people out of five experience back pain at least once a life. Most of the problems tend to be related to the lower back. The reasons for back pain can be different, such as weak muscle tone, overweight, hard physical labor, lifestyle, muscle diseases, and traumas. Traumas and hard physical work may induce disc herniation (also called slipped disc) in the vertebra and as a result, the discs start to compress on the nerves, causing strong pain. This condition, which is known as radiculopathy, tends to recur even after successfully treating the first episode. In most cases, changes in lifestyle (training, ergonomic working posture etc), painkillers, muscle relaxants and massage are enough to alleviate the condition. In more complicated cases – when the lower body and legs have become paralyzed, for example – back surgery is indicated.
Traumas and overload-related injuries
Other more frequent traumatic injuries include ruptures of the inner structures of the knee, such as the meniscus and anterior or posterior cruciate ligament. To visualize, diagnose and treat intraarticular problems, a procedure named arthroscopy is often used, whereby a camera (to visualize the problem) and sometimes also other instruments (necessary to perform the treatment) are inserted through a small incision made in the knee region.
Ruptured Achilles tendon, also called ruptured heel cord, is a frequent traumatic injury, especially in younger people and athletes. Its characteristic symptom is inability to stand on tiptoes. Achilles tendon rupture must be treated surgically. In case of a recent trauma, the Achilles tendon is sewn together; in case of an older rupture, one possible treatment option is tendoplasty. In certain rare cases, conservative treatment (plaster cast or special orthosis) can be applied.
Ankle joint is another region susceptible to sprains, falls, and other primarily sports-related traumas. Strains and ruptures of the ligaments in this region are very common.
One particular overload- or trauma-related disease is the carpal tunnel syndrome, which is the most frequent in middle-aged women. Carpal tunnel syndrome results when the nerve that runs through the carpal tunnel (wrist canal) becomes constricted. The symptoms include pain in the wrist and hand alongside with numbness and tingling in the thumb side of the palm. Quite often conservative treatment (rest, orthoses, physiotherapy) gives a very good result, however, in more complicated cases, surgery could be indicated.
Another hand-related disease is the Dupuytren contracture, caused by the thickening of the palmar fascia (palmar aponeurosis) as a result of which one or more fingers become bent in a flexed position. Most often, the fourth and fifth fingers are affected. When the disease progresses, the mobility of fingers decreases gradually, until they become permanently bent and immobile. It is thought that the disease has a strong genetic predisposition, but various factors, such as smoking, alcohol consumption, rheumatoid arthritis, traumas and hard physical labor, increase the risk. Unfortunately, the disease is untreatable, but its symptoms can be alleviated.
Hallux valgus is a condition where the big toe tilts over towards the smaller toes. It is one of the most frequent foot-related problems, caused by the weakening of the muscles that keep the big toe straight. As a result of wearing too tight or unsuitable shoes for a long time, the big toe may tilt towards or on the neighboring toe. In an early stage, the problem can often be alleviated by means of massage, orthoses, ultrasound therapy and electrotherapy. In more serious cases, surgical intervention is necessary.
Flat feet are caused by a congenital or acquired deformation of the feet, characterized by the flattening of the longitudinal and transverse arches of the foot. The reasons for this roblem include nerve and muscle diseases, but also wearing unsuitable shoes. Sometimes the person with flat feet is free of complaints, but sometimes he or she may experience pain caused by foot overload. However, it should be noted that in infants the arches of the sole do not develop until a certain age and it is perfectly normal. Walking barefoot and special exercises promote the development of proper arches.
Similarly to flat feet, knock knees (X-legs) and bow legs (O-legs) are normal at certain ages. All children are born with bow legs. In the second and third year of life, slight knock knees are the norm. Only by school age, the legs become comparatively straight. In case of a prominent deformation that causes symptoms, it is advisable to consult an orthopedic surgeon.
Decompressive lumbar laminectomy€2000–€7000
Decompressive lumbar laminectomy is a surgical procedure to treat lumbar radiculopathy, lumbar disc herniation and spinal stenosis. The operation is undertaken to relieve the pressure on the spinal canal, free the compressed (impinged) nerve root and restore the integrity of the vertebral column. This procedure is indicated in cases of chronic (that is, permanent) back pain that is resistant to conservative treatment (drugs and physiotherapy), and makes walking difficult or causes weakness and numbness in legs. In addition, impingement of spinal nerves may cause problems with urinating or defecating – if that is the case, immediate operative treatment is indicated. The patient may stand up from the bed in the evening of the first post-operative day already, however, it is not advisable to return to work before 4–6 weeks, depending on the nature of the work.
Orthopaedic surgeon’s consultation€25–€132
An orthopaedic surgeon specializes on diagnosing, monitoring and treating chronic and acute diseases of the human skeletal system and associated structures (bones, joints, ligaments, tendons and muscles). During the first appointment, the orthopaedic surgeon usually examines the patient and prescribes necessary tests and analyses. This doctor can also give advice about the prevention of bone and joint disorders and plan subsequent treatment.