Orthopaedic surgery is reserved for patients, who did not improve with conservative management or for whom surgery is the only chance to restore function of the extremity (i.e. arm or leg), such as patients after road accidents or sports-related injuries (fractures, dislocations, tendon or ligament tear).
Orthopaedic surgery can be divided into:
Superior cervical segment (C1-C4 vertebrae)
Back head pain, which may also radiate to supraclavicular area,
is typically diffuse and accompanied by increased muscle tone. If your pain is very localised and does not radiate it may suggest an injury, that is, an isolated, non-dislocated vertebral body fracture. If you experience radiating pain, it may suggest nerve compression at that level, which is a sign of degenerative disc disease. Magnetic resonance imaging (MRI) is the basic diagnostic assessment.
Inferior cervical segment (C5-C7 vertebrae)
If the pain is localized, stabbing, burning and increases with compression, it may suggest inflammation, degeneration of vertebral joints or an isolated, non-dislocated vertebral body fracture. If it radiates along the entire or a part of your arm, and is accompanied by numbness or “pins and needles”, it may be a sign of degenerative disc disease.
Many people complain about shoulder pain. If neglected, shoulder pain may lead to serious, irreversible damage to your locomotor system, causing strong pain and severe mobility reduction. Shoulder pain can have a number of causes. Basic signs of shoulder dysfunction include pain and instability. Limited range of motion, reduced/ limited function, tenderness and swelling.
Inflammatory conditions damage the cartilage in the shoulder. The joint is also susceptible to acute injuries and recurrent microinjuries. Degenerative joint disease is the most common cause of shoulder pain and its reduced mobility. Its typical symptoms involve pain around the shoulder which increases with activity, as well as reduced range of motion. Snapping and cracking sounds may also be heard. It should be differentiated from other causes, such as rotator cuff injury, bursitis, tendinitis or other conditions.
The elbow consists of humeroradial and humeroulnar joints, which are responsible for flexion/ extension and the proximal radioulnar articulation (superior radioulnar joint), which along with distal radioulnar articulation (inferior radioulnar joint) control pronation/ supination of the forearm.
Elbow pain is often associated with degenerative and inflammatory lesion concomitant with bursitis or tendinitis. Majority of patients reporting elbow pain are diagnosed with osteoarthritis (degenerative joint disease), overuse injury, post-traumatic arthritis, tendinitis or bursitis. Olecranon bursa is located at the back of the elbow. It may get inflamed as a result of an injury or overuse. Other bursae susceptible to inflammation are present between the insert of the biceps and the radial head (bicipitoradial bursa), in the pre-cubital and cubital area. Along with pain, patients report progressive mobility reduction, which interferes with such simple activities as typing, holding the cup or closing doors. The pain increases with movement and lessens with rest.
A hand performs 90% of all upper extremity functions. The thumb is the most active among all fingers and performs 50% of all-finger function, with the index finger being the second active one. Wrist and hand injury treatment is necessary to maintain their function and prevent disability. Wrist and hand problems can be manifested as pain, morning stiffness, swelling, limited mobility, decreased muscle strength, numbness. Carpal tunnel syndrome is the most common compression neuropathy, potentially caused by improper wrist and hand positioning when typing. It must be carefully assessed to be differentiated from cervical radiculopathy which may mimic the compression of the median nerve. The post-injury swelling persisting for more than a few days may indicate wrist fracture. Carpometacarpal arthritis may cause pain and decrease grasping force. Snapping finger is caused by microinjuries due to repeated thumb pressing movements. Hand pain is a common complaint. Metatarsophalangeal arthritis should be differentiated from stress fracture and other occult phalangeal pathologies. Accurate diagnosis is important to determine the affected structures and choose appropriate treatment – conservative or surgical.
Thoracic segment (Th1-Th12 vertebrae)
Thoracic segment pain associated with degenerative and inflammatory conditions as well as degenerative disc disease is localized and accompanied by the increased neck muscle tone. The pain may increase when taking a deep breath, or changing position (sitting up, standing up etc.). It can be unilateral (on one side only), sharp, stabbing, piercing your chest or radiating along the ribs. It is usually caused by degenerative disc disease of the thoracic segment. The diagnostic assessment involves clinical evaluation and magnetic resonance imaging (MRI).
Lumbar segment (L1-L5 vertebrae)
Lower back pain is usually caused by inflammation and degeneration of vertebral joints or degenerative disc disease. The pain is accompanied by the increased tone of paravertebral (i.e. back) muscles. The pain is more severe when changing position and pressing the affected area. With degenerative disc disease, the pain may radiate to your legs. Additionally, you may feel numbness and/or burning (‘pins and needles’) and decreased muscle force in legs and buttocks. In some cases, the pain is so severe, that a patient finds it difficult to stand. It may be unilateral (on one side only). The diagnostic assessment involves clinical evaluation and magnetic resonance imaging (MRI).
Sacral segment (S1-S5 vertebrae)
Sacral pain usually radiates to the posterior part of legs and buttocks. Sacral pain is closely related to abnormalities in lumbar spine, with the only exception being isolated sacral bone injury. The diagnostic assessment involves computed tomography (CT) and magnetic resonance imaging (MRI).
Hip is a ball-and-socket synovial joint: the ball is the femoral head, and the socket is the acetabulum. It is well equipped to support the weight of the body in both static and dynamic postures. It shifts the weight of the body from the trunk to legs and makes it possible to move them. A hip is one of the biggest human joints, which has a wider range of motion than other joints. Hip stability affects knees and lumbosacral area. An unstable hip may lead to overuse injury of the knees and lower back. Hip is capable of three types of movements: sideways movements (known as abduction and adduction), rotation (inward and outward), and forward/ backward movements (known as extension and flexion). A hip has a solid structure and unchangeable shape. All imbalance between stability and mobility may cause injury to the soft tissue of the joint and any surrounding tissues, as well as joint dysfunction. Interestingly, hip problems can indicate pathology in other parts of the body, so the clinical assessment also involves lumbar spine, pelvis and knees. Hip pain may be caused by degenerative joint disease, osteonecrosis, inflammation, proximal femoral fracture or pelvic fracture. Morning stiffness is a sign of rheumatoid arthritis.
Knee is a hinge joint connecting the femur (thigh bone) and the tibia (shinbone). The patella (knee cap) also forms a part of your knee. Knee is a very strong joint. It is the second most loaded joint in human body (with ankle being the first one). It can flex and stretch. A wide range of motion of the hip and ankle makes it difficult to maintain the knee in its proper position, thus making it susceptible to instability. Knee stability depends on a number of factors including: static limitations set by the joint capsule, ligaments and the menisci; as well as dynamic limitations set by the muscles (quadriceps femoris, biceps femoris and the gastrocnemius muscle). Ligaments and cartilage provide the structure of the knee joint. Soft tissues (ligaments, fascia) ensure knee stability in motion, and ensure proper position of the bones, thus eliminating unwanted joint movements. It should be noted that the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are the most susceptible to injury out of all knee ligaments.
Foot and ankle are complex structures composed of bones, muscles and ligaments which ensure stability and equal spread of forces exerted on a foot when standing, running or walking. The ankle is the most susceptible to injuries. Most injuries occur when the foot is in plantar flexion, supine and adducted. Foot and ankle can be in dorsiflexion or plantar flexion; they can turn outwards (pronation/ eversion) or inwards (supination/ inversion).
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