The Orthopaedic Evaluation: It’s All In The Mechanics – By William P. Rix, M.D.

Posted on January 12, 2012 by NHOC Tech under Dr. Rix, Featured Articles

“Scratch an orthopedist and you`ll find a carpenter”.  There is truth in this old saying, as both occupations use mechanical principles in their daily work.

Pain, stiffness, weakness, and instability are common symptoms that prompt people to seek orthopedic advice.  We search for the diagnosis, medical or surgical, but our focus is on an orthopedic explanation.   In other words, we look for a mechanical abnormality that involves muscle, tendon, ligament or bone.

Mechanical abnormalities include cartilage wear, torn ligaments, strained muscles or tendons, joint instability, pinched nerves, fractures and so on.   Rubbing, wearing, tearing, straining, stretching, slipping, breaking, pressing, pinching, sticking, locking, snapping and catching  are the terms in which we think in searching for a diagnosis.

Our approach  is a mechanical one.

For example, when a person presents with shoulder pain, we look for common mechanical causes such as arthritis (wearing down of cartilage), frozen shoulder (stiffening of the shoulder capsule), pinched nerve or rotator cuff tear. If “knee buckling” is the complaint, the orthopedist suspects knee or hip arthritis, a torn knee cartilage, or knee cap instability.

Sometimes a condition which presents as orthopedic can be due to other causes. In our examples for instance, shoulder pain can be caused by a heart or lung problem and knee buckling by diabetes, Multiple Sclerosis, or old polio.

That is why you may sometimes hear us say, “I don’t know what is causing your symptoms, but it’s not orthopedic.”  In other words, we can’t find a mechanical cause that involves the musculoskeletal system.  At this point we might recommend a referral back to your primary physician or to a specialist in another field, such as a neurologist.

There are many causes of the common complaints of pain, stiffness, weakness, and instability.   Most, but not all, have an orthopedic basis. We do our best to find the correct diagnosis but we`re best at finding an orthopedic one.