When bones hurt, break or become diseased, you need a bone doctor to take care of them. Bone doctors are specialists in orthopaedics – also spelled orthopedics – the medical treatment of bones and joints. Within the orthopedic field there are several different types of bone doctors. They deal with a wide range of problems, including cancer, arthritis, children's health and sports-related injuries.
What Is a Bone Doctor Called?
Bone doctors have been known as orthopaedists or orthopedists for more than 300 years. They derive the name from the Greek prefix "ortho," meaning "straight." Bone damage bends our bodies out of the proper alignment; bone doctors straighten us out. Lots of body parts need straightening, so other types of doctors use the prefix, such as orthodontists, who specialize in straightening teeth.
French physician Nicholas Andry coined "orthopaedist" back in the 1700s. That's the spelling medical schools use, even though "orthopedist" is common in regular conversation. Along with orthopedists, bone doctors include orthopedic surgeons and orthopedic oncologists.
Doctoring Our Bones
Despite the prefix, orthopedists and orthopaedic surgeons do more than just straighten out bones. Problems with bones and joints often lead to pain, so orthopedists learn to diagnose such pain and find the cause. When you arrive at the office, the first step in treatment is often an evaluation, during which you are asked specific questions about your pain: Where exactly does it hurt? Is it constant or only when you do particular activities? How long does it last?
X-rays help bone doctors pinpoint the problem. Pain in your ankle, for example, could be arthritis, a bone cyst or a broken bone, among other possibilities. An X-ray will give the doctor a clear look at the bone, which may be enough to identify what's wrong. An MRI, which uses a magnetic field, can look for tears or damage to bones or tendons that an X-ray doesn't pick up. Arthroscopy uses a miniaturized camera to look inside your body.
The bone doctor you're seeing may be an orthopedist or an orthopedic surgeon. Going to a surgeon doesn't mean you're going under the knife. Once the surgeon identifies the problem, he may recommend surgery, or may instead suggest physical therapy or simply give you a shot of cortisone, a powerful pain remedy.
What bone doctors do overlaps and interacts with the practices of other specialists. An orthopedic doctor might specialize in osteogenesis imperfecta, a genetic disorder that causes fragile bones. An osteogenesis imperfecta clinic might also have a geneticist, an endocrinologist, a nephrologist, a neurologist, a physical therapist, an occupational therapist and a nutritionist on staff.
Operating on Bones
Some of the conditions and diseases an orthopedic surgeon treats include:
- Abnormalities of the fingers and toes
- Back pain, ruptured disks, sciatica and scoliosis
- Bone tumors
- Muscular dystrophy
- Cerebral palsy
- Club foot, bunions and bow legs
- Bone fractures and dislocations
- Growth abnormalities
- Tendon injuries, pulled muscles, bursitis, torn cartilage
- Torn ligaments, sprains and strains.
Bone surgeons use several specialized techniques to treat patients. They can weld damaged bones together by fusing the bone, bone grafts and metal rods into a single, solid piece. With internal fixation, surgeons use plates, pins or screws to hold the bone in place while it heals. They replace joints such as hips or knees with artificial joints. Osteotomy treatments correct bone deformity by cutting and repositioning the bone. Bone surgeons also mend torn tissues and ligaments.
Treating Bone Cancer
Bone cancer is one of the crossover diseases that can involve multiple specialists: oncologists, orthopedic oncologists, orthopedic surgeons. Surgery is the preferred treatment for most types of bone cancer. If the patient needs a biopsy to remove some of the tumor or bone for testing, the same surgeon generally does both operations. That's because taking the biopsy from the wrong place can lead to problems when time for the main surgery rolls around.
The goal of the operation is to remove every last bit of cancer from the bone. To avoid missing any cancer cells that could regrow later, bone surgeons often use a wide excision, cutting away some of the healthy bone as a precaution. Doctors favor surgery, because other treatments aren't as effective on the bone. Radiation doesn't work well on bone cancers unless the orthopedic oncologist uses dangerously high levels. Most bone cancers aren't affected by chemotherapy, though a few, such as osteosarcomas, are vulnerable.
Healing Sports Injuries
Bone doctors and sports medicine are a natural match. It's not just the possibility of broken bones, but also cartilage tears, damage to the knees, and strain or damage to other joints. All of those fall into the orthopedic field. Lots of people in everyday life suffer similar injuries, so a sports medicine practice may also treat clients who aren't athletes. Some primary-care doctors also specialize in sports medicine. They can diagnose and treat many kinds of sports injuries, but can't provide orthopedic surgery.
Replacing the Joints
Some bone surgeons specialize in joint replacement. Human joints can wear out over time, or from injuries that damage the cartilage. Medication, physical therapy and lifestyle changes can sometimes fix joint pain or stiffness. If they don't do the job, total joint replacement is an option. This is a surgical procedure that switches out key parts of the damaged joint for a metal, ceramic or plastic prosthesis. The substitute replicates the movements of a normal, healthy joint. To fix an arthritic hip, for example, the surgeon replaces the ball of the femur bone, which rests in a hip socket, with a metal ball. Plastic replaces the original hip socket.
Bone surgeons routinely replace hip and knee joints with prostheses. It happens less with other joints, such as the elbow, but it's also possible to trade them out for cyborg-like parts.
Working With Children's Bones
Pediatric orthopedics is another bone doctor specialty. Children's bones are different from those of adults, because their bodies are still growing. That creates problems that don't exist in adult patients. Even if the ailment is common to all ages, the evaluation and treatment in a kid is different. Something that would be a problem in adults may simply vanish as a child grows.
Intoeing is a good example. Often called being pigeon-toed, it's a condition in which the feet point inward instead of straight ahead when a child walks or runs. It doesn't cause pain, and a child younger than eight will usually grow out of it. Only a minority of cases require orthopaedic surgery.
Specializing in Spines
Many orthopedists specialize in particular areas of the body. Because of the demands of holding up the body, the spine suffers all kinds of injuries – from back pain to sports injuries to spinal deformities such as kyphosis. It's more than enough for an orthopedic surgeon to build a career on.
The spine is another of those areas where orthopedics overlaps with another field – in this case neurosurgery. Bone surgeons are often more qualified at treating spinal deformity, though in the 21st century, many neurosurgeons are also trained in that type of operation. A neurosurgeon is probably more qualified if the operation involves the dura, the tissue around the spinal cord.
Choosing to Be an Osteopath
An osteopath is a different kind of bone doctor. They don't even have an MD (medical doctor) after their names, receiving a degree as a DO – doctor of osteopathic medicine – instead.
Andrew Taylor Still founded osteopathy in the 19th century as an alternative to conventional medicine. He based the discipline on the belief that most diseases were symptoms of underlying problems with the musculoskeletal system. By manipulating bones or muscles to restore the body's proper alignment, Still believed, osteopaths could treat or cure the disease. Back then, osteopathy was radically different from regular medicine. In the 21st century, though, DOs aren't so different from MDs. If you go to an osteopath, she may do blood work, check your temperature and take X-rays to diagnose your condition. DOs often use the same kind of prescription drugs and surgical treatments as MDs. However, they may also treat you by manipulating joints or muscles. For example, suppose you come in with chest pain. An osteopath will use standard treatments if it's heart disease or pneumonia, but if a rib is displaced, they'll apply osteopathic manipulation.
Mt. Sinai Hospital cautions against using osteopathic manipulation to treat broken bones, bone cancer, joint infections, arthritis or osteoporosis. It's good for back and neck pain; some sufferers are able to cut down on their pain medications after visiting an osteopath. There's some evidence showing osteopaths can treat joint pain, tennis elbow, fibromyalgia and other conditions too.
Chiropractic Bone Doctors
Chiropractors are another type of bone specialist, sometimes confused with osteopaths. Like osteopathy, chiropractic treatment focuses on the relationship between the body structure, particularly the spine, and general health. Chiropractors manipulate the spine to put the body into better alignment, ease pain and improve function. Physical therapists in conventional medicine sometimes use similar techniques. Chiropractors also use temperature treatments and relaxation training to ease pain and loosen stiff muscles.
Chiropractors aren't medical doctors, though they are required to have Doctor of Chiropractic degrees from an accredited college. Chiropractic programs run four years, combining classes with hands-on training. At the end of the program, students take a licensing exam that they must pass before they can practice. There are 100-plus chiropractic methods; like an MD, a chiropractor may take a residency to specialize in a particular type of chiropractic. Other practitioners specialize by integrating several different methods.
Nursing the Bones
Along with bone doctors, there are also specialized bone nurses. Orthopedic nurses help assess, diagnose and treat patients with damaged bones, tendons and muscles. Their duties can include physical exams, taking the patient's medical history, setting bones and providing painkillers. They may assist during surgery or administer post-op care. Physical therapy is important as an alternative to surgery and for recovering after an operation. Nurses may work to help patients regain some of their mobility.
Becoming a Bone Doctor
Going into orthopedics, like any field of medicine, is tough. Medical school takes several years of demanding schoolwork, no matter which specialty you're interested in. After medical school comes the medical exam, and then several years as a resident, or doctor in training.
The first two years of medical school are alike for all students. In the third year, the school rotates students through various specialties, exposing them to different options. In the fourth year, students can choose rotations that interest them – such as orthopedics, surgery or children's health – and start to specialize. When a bone doctor is choosing a residency, he looks for one in the orthopedic field.
Even within the orthopedic field, bone doctors specialize. An orthopedic surgeon, for instance, takes surgical training that other orthopedists don't have. A surgeon who's interested in sports medicine may sign up for additional training in surgical sports medicine. A bone doctor who wants to work in pediatric orthopedics will look for a residency in that field. Osteopaths attend osteopathic medical schools to earn a DO.