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Orthopedic Consultation: 2020 Options

orthopedic consultation

The COVID pandemic continues to make daily life and management of pain a challenge.  When should you see an Orthopedic Doctor?  What happens at an orthopedic consultation?   What can an Orthopedic Doctor do for me?  Are there other nonsurgical options?  Let’s dig in.

When Should I See an Orthopedic Doctor?

There are multiple reasons to seek an orthopedic consultation.  The major reasons include:

Escalating Pain

Severe pain if left untreated can cause additional and potentially permanent injury.  Patients with uncontrolled pain may start or increase their opioid use putting them at risk for addiction.

Difficulty Moving

Difficulty moving due to knee, back and hip pain can cause many problems and put patients at risk for blood clots and pneumonia.

New Instability While Walking

Patients that are unstable while walking due to joint and spine pain are a risk for falls, fractures, and bleeding.

Recent Injuries Not Improving

Injuries that are unresponsive to conservative care which includes rest, physical therapy, heat, elevation, and chiropractic warrant an orthopedic evaluation.

What Happens at an Orthopedic Consultation?

A good quality orthopedic consultation should include 5 principal components

History:  Areas covered should include the onset of the injury, aggravating and alleviating factors, presence or absence of swelling, instability, restricted range of motion and treatment to date.

Past Medical History:  Current medications, allergies, medical conditions, and a list of prior surgeries.

Physical Examination:  A number of physical tests to assess movement, gait, range of motion of affected joint, stability, swelling, reflexes and muscle strength.

Review of Studies:  X-rays, MRI’s and CT will be reviewed in detail.

Treatment Plan: Based on history, physical examination findings, radiographic studies a treatment plan will be provided.  The risks and the benefits are outlined and all questions answered.

What Can an Orthopedic Doctor do for Me?

The vast majority of orthopedic doctors are surgeons who have only four treatment options to address your ongoing pain complaint.

#1 Do nothing.  They will tell you that you are not a candidate for surgery or surgery will not help you.  Next, the door opens and they exit the room.

#2 Referal to Physical Therapy.  At present many PT offices are closed.  Hospital PT offices are overwhelmed with inpatient and outpatients and put patients and loved ones at risk for viral injection.

#3  Medication management.  They may recommend a trial of NSAID to decrease inflammation.  Steroid injections also are a common recommendation when PT and NSAIDs fail.  NSAIDs have many significant side effects including increased risk of heart attack and negatively impacting your stem cells (1).  Steroids also have significant side effects and are toxic to orthopedic tissue including cartilage (2).  In addition, NSAIDs are thought to accelerate viruses whereas steroids can compromise your immune system and your ability to fight off infections (3).   Both should be avoided.

#4:  Surgery.  Most orthopedic clinics and ambulatory surgery centers are closed.  Many states including Colorado have put bans on elective surgeries.  Hospital operating rooms are treating patients with viral complications and should be avoided.  Surgery is not always the best treatment option.

During these challenging times, traditional medicine has little to offer patients with ongoing pain and limitations.  Are the other options?

Telemedicine at the Centeno-Schultz Clinic

The Centeno-Schultz Clinic has been the leader in regenerative medicine and Interventional Orthopedics for the last 15 years. We treat common orthopedic conditions using precise injections of PRP and bone marrow concentrate.  The treatments are non-surgical and do not have the risks or the extensive rehabilitation associated with surgery.  Our outcomes are available online by clicking here.  Our list of publications is here which consists of approximately 40% of the published literature in the world on orthopedic stem cell treatments.  We were the first practice in the world to inject bone marrow concentrate into a low back discs and we pioneered the use of stem cells in the treatment of ACL tears.  A telemedicine consultation is a real-time consultation from the comfort of your home or office.  You will speak with a board-certified, fellowship-trained physician who can review your history, surgical history, MRI and x-ray.  In addition, you will be provided a self-examination video which will allow a much better understanding of your conditions and your current limitations.  After reviewing the information and self-exam results an assessment and treatment plan can be established.  You may come to learn that surgery is not your best option.  How to start?

  1. email  [email protected].
  2. No internet access?  Not a problem.  Call 720 669 8330
  3. No X-rays or MRIs?  Not a problem as new patient evaluations and follow up consults do not need imaging.
  4. No computer?  Not a problem as telemedicine can be completed in the comfort of your home on a cell phone or tablet.

In Conclusion

The evaluation and treatment of orthopedic pain is dynamically changing.  Reasons to schedule an orthopedic consultation include escalating pain, difficulty moving, instability, and new injuries that are not improving.  During a consultation, the history of the injury is discussed along with past medical and surgical history and radiographic results.  After the physical examination, an assessment is made and a treatment plan recommended.  Most orthopedic physicians are surgeons with 4 treatment options:  Do nothing, PT, medications, and surgery.  Medications such as NSAID and steroids have significant side effects and should be avoided.  At present elective surgeries are not being performed.   Telemedicine with Centeno-Schultz Clinic is a new, novel way to have orthopedic pain evaluated.  It offers patients an opportunity to review their current pain, past medical and surgical history and review of radiographic imaging with a fellowship-trained physician from the comfort of their home.  Child and eldercare issues along with traffic and risk of viral exposure are gone.  Treatment options include PRP and bone marrow concentrate both of which avoid the risk of surgical complications and infection.

1.Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086.

2.McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-75.

3. Ciriaco M, Ventrice P, Russo G, et al. Corticosteroid-related central nervous system side effects. J Pharmacol Pharmacother. 2013;4(Suppl 1):S94–S98. doi:10.4103/0976-500X.120975.