An orthopedic doctor specializes in the musculoskeletal system: your bones, joints, ligaments, tendons, muscles, and nerves. That covers everything involved in how you move, from your spine down to your toes. Some orthopedic doctors focus primarily on nonsurgical care, while orthopedic surgeons are trained to operate when conservative treatments aren’t enough. In practice, most do both.
What the Musculoskeletal System Includes
Your musculoskeletal system is essentially your body’s structural framework and movement machinery. Orthopedic doctors treat problems in all of it: the 206 bones in your skeleton, the cartilage cushioning your joints, the ligaments connecting bone to bone, the tendons attaching muscle to bone, and the nerves running through and around all of these structures. A problem in any one of these tissues can cause pain, weakness, stiffness, or loss of function, and that’s where an orthopedic doctor comes in.
Conditions They Treat
The range is broad. On the chronic disease side, orthopedic doctors manage osteoarthritis (the wear-and-tear breakdown of joint cartilage), rheumatoid arthritis, scoliosis, herniated discs, bursitis, carpal tunnel syndrome, and osteoporosis. On the acute injury side, they handle fractures, torn ligaments like ACL tears, rotator cuff injuries, dislocations, and sports injuries of all kinds.
Some of these conditions overlap. A weekend soccer player who tears cartilage in their knee needs acute surgical evaluation. A 60-year-old with decades of knee cartilage wear needs long-term arthritis management. Both see an orthopedic doctor, but the treatment paths look completely different.
How They Diagnose Problems
An orthopedic visit typically starts with a physical exam, where the doctor tests your range of motion, checks for swelling or tenderness, and asks you to reproduce the movements that cause pain. From there, imaging often fills in the picture.
X-rays are the first-line tool for evaluating bones, fractures, and joint alignment. MRI scans use magnets and radio waves (no radiation) to create detailed images of soft tissues like tendons, ligaments, and cartilage, making them especially useful for suspected tears. CT scans combine X-rays with computer processing to produce detailed cross-sectional views of bone and soft tissue, and they take less than 30 minutes. Musculoskeletal ultrasound is particularly helpful because it creates images in real time while you move, letting the doctor see exactly what happens in the joint during the motions that cause your pain.
For more specialized situations, doctors may order a bone density scan to measure bone mineral content (commonly targeting the hip and spine to assess osteoporosis risk), a nuclear bone scan that uses a small amount of radioactive dye to highlight infections, tumors, or abnormal bone cells, or an arthrogram, which injects contrast dye into a joint before X-ray to get a clearer picture of the space inside.
Nonsurgical Treatments
Surgery is not the default. Orthopedic doctors spend a significant portion of their time managing conditions without operating. Common nonsurgical approaches include:
- Physical therapy: Customized exercise programs designed to restore flexibility, strength, and function. This is often the first recommendation for joint pain, post-injury recovery, and chronic conditions.
- Cortisone injections: These reduce pain and swelling in joints including the hands, hip, knee, shoulder, spine, and wrist. They’re commonly used for arthritis, carpal tunnel syndrome, and tendinitis.
- Gel injections: Also called viscosupplementation, these add lubricating fluid to a joint. They’re most commonly used for knee arthritis.
- PRP (platelet-rich plasma) injections: These use cells from your own blood to accelerate healing in damaged tendons, ligaments, muscles, and joints.
- Bracing and casting: Immobilizing an injured area to allow healing, commonly used for fractures, sprains, and post-surgical recovery.
- Shockwave therapy: A noninvasive treatment that uses sound waves to stimulate healing in injured ligaments and tendons, particularly for overuse injuries like Achilles tendinitis.
Pediatric orthopedics, in particular, leans heavily nonsurgical. Children’s changing growth patterns mean many conditions can be guided toward correction with bracing, casting, or monitoring over time, and more patients in pediatric orthopedics are treated without surgery than in any other orthopedic subspecialty.
Surgical Procedures
When surgery is necessary, orthopedic surgeons use a range of techniques depending on the problem. Arthroscopy is one of the most common. The surgeon inserts a narrow tube with a fiber-optic camera through an incision about the size of a buttonhole, allowing them to see inside the joint and repair damage through similarly small incisions. It’s used on knees, shoulders, elbows, ankles, hips, and wrists to treat torn cartilage, torn ligaments, loose bone fragments, inflamed joint linings, and scar tissue.
Joint replacement surgery removes damaged portions of a joint and replaces them with metal, plastic, or ceramic components. Hips and knees are the most commonly replaced joints, typically for patients with advanced arthritis that hasn’t responded to other treatments. Spinal surgeries, including fusions and disc procedures, address herniated discs, spinal deformities, and degenerative conditions. Fracture repair may involve plates, screws, or rods to stabilize broken bones while they heal.
Orthopedic Subspecialties
Many orthopedic doctors narrow their focus to a specific body region or patient population after completing their general training. The main subspecialties include:
- Sports medicine: Focuses on injuries from athletic activity, including ligament tears, overuse injuries, and cartilage damage.
- Hand and upper extremity surgery: Covers the hand, wrist, elbow, and shoulder. Hand surgeons treat everything from sports injuries to congenital anomalies, and some perform microsurgical procedures like reattaching amputated fingers.
- Spine surgery: Addresses conditions ranging from scoliosis and spinal deformity to degenerative disc disease, using techniques like spinal fusion and instrumentation.
- Trauma: Specializes in acute fracture management and stabilization, covering all body regions and age groups. Trauma surgeons often work in emergency settings.
- Pediatric orthopedics: Treats children exclusively, covering every anatomic area. Many patients require years of follow-up as their growth and development create changing treatment needs.
- Joint replacement (adult reconstruction): Focuses on replacing damaged joints, primarily hips and knees.
- Musculoskeletal oncology: Treats benign and malignant tumors of bone and soft tissue in the limbs and sometimes the spine.
Training and Education
Orthopedic doctors complete four years of medical school followed by a five-year residency in orthopedic surgery. Those who subspecialize add a one- to two-year fellowship on top of that. By the time an orthopedic surgeon is fully trained, they’ve completed a minimum of 13 years of education and clinical training after high school.
When to See an Orthopedic Doctor
Certain situations call for an immediate or urgent orthopedic evaluation: fractures, significant sprains, sudden loss of bowel or bladder control (which can signal a spinal emergency), sudden neurological deficits like new weakness or numbness in a limb, and acute sudden onset of severe pain. These are situations where waiting can lead to worse outcomes.
For non-acute problems like chronic joint pain, stiffness, or nagging injuries, the general guideline is to seek an orthopedic consultation when symptoms have persisted beyond six weeks despite rest or basic self-care. If you’re experiencing numbness and tingling in your hands or arms, your primary care doctor may order nerve conduction testing before referring you, since those results help the orthopedic doctor plan treatment more efficiently from the first visit.