Page 91 - ASOP ROT Study Guide

physiotherapists, occupational therapists and technicians. These professionals make up the orthopedic
management team.

To illustrate the orthopedic team in action, we can try to answer the original question:

Most people who suffer joint pain start by taking simple drugs such as aspirin and paracetamol. If this proves
ineffective, they consult their GP who can prescribe stronger painkilling drugs and contact the community
services to provide help. If these measures prove unsatisfactory, the GP may decide to refer the patient to an
orthopedic specialist. The orthopedic surgeon would determine whether surgery was necessary and, in
conjunction with an anesthetist, whether the patient was in good enough health for an operation. Junior
doctors and nurses make preparations for the operation. The orthopedic surgeon is assisted during surgery, by
anesthetists, specialist nurses, junior doctors and porters. Physiotherapists, occupational therapists, the GP
and the community services (social workers, home helps, meals-on-wheels etc.) will make preparations for
convalescence and recovery. So much for the old saying of the doctor "my patient"!

1 . 4 Treatment Aims and Objectives

Of course our real goal is to return people to normal. Unfortunately, that goal is seldom achieved in any branch
of medicine. As described above many conditions will get better anyway and many are, at the moment,
incurable.

In most cases therefore, we cannot achieve a cure but we may try to relieve the patient of their principal
complaints - pain and stiffness. Most joint replacement surgery is aimed at pain relief, and it is inaccurate to think
of an artificial joint being a cure. It is really a salvage operation to remove the damaged joint and replace it with
a pain free substitute which will never be as good as the original. It is essential that everyone treating
musculoskeletal disorders understands that relief of symptoms is our goal.

1 . 5 Types of Orthopedic Problems

Many illnesses or "conditions" of the musculoskeletal system are temporary and will get better. We call such
conditions "self-limiting". Good examples of self-limiting conditions include muscle tears and ligament sprains.
On the other hand, many conditions are permanent and have no specific cure. Examples of disorders of this
nature include arthritis and abnormalities of birth (congenital abnormalities) which have permanent effects
which the orthopedic team have to try and alleviate.

Traditionally, we may define orthopedic disorders according to the origin of the disease. This is somewhat
unsatisfactory because we do not always know what causes a disorder. It is nevertheless important to know
about this classification as it is still in common usage.

Congenital abnormalities - these are defects associated with development in the womb. They may have a
familial or genetic cause or they may be the result of something happening to the mother or to the child whilst in
the womb. For example, if the mother has German Measles during pregnancy then the child may have some
birth defects. Another example is the child who may be normal until birth and then suffer a lack of oxygen
during the process of being born resulting in injury to the brain. This then affects the development of nerves
and muscles, causing a combination of mental and physical problems known as cerebral palsy, or more
loosely "spasticity".

Inflammatory abnormalities - these illnesses may be associated with bacterial infection causing
inflammation of a joint (infective arthritis) or of bone (osteomyelitis). Sometimes the cause of the inflammation
is not known. An example of mis is a whole body disease known as rheumatoid arthritis which leads to
stiff and very painful joints. This group in this system of classification is particularly unsatisfactory because
the cause of many inflammations are unknown.

Metabolic disorders - this is a term indicating a group of illnesses which usually cause inflammation, but
the cause can be traced back to some abnormality in body metabolism. A good example is gout, which is an
inflammation of a joint caused by crystals being deposited on the cartilaginous surface of joints. The crystals
are uric acid which is a waste product of cell metabolism. Why the cell metabolism has gone wrong is not
properly understood in most cases but at least the cause of the pain can be explained.
Abnormalities of vitamin metabolism such as poor absorption of nutrients from the gut, or a dietary deficiency