Specialty Area: Orthopedics

Description of Specialty: Orthopedic surgeons treat injuries, symptoms and problems associated with the musculoskeletal system, that is the trunk, including the neck, back and pelvis, and/or the extremities, including the arms or legs.

1. Diagnosis: Low Back Pain

Questions that should be asked:

1. What needs to be done to make the diagnosis?
2. Are any special studies needed?
3. Can you order these tests?
4. Are these tests covered by my insurance company?
5. Do you have to get special permission from my insurance company to order these tests?
6. Are these outpatient tests?
7. Are they invasive procedures?(Am I stuck with a needle? or, Is any dye or medicine injected in me?)
8. What are the risks and complications of invasive procedures?
9. How soon can they be done and how urgent is it for these tests to be done?
10. Is the pain transient?
11. Is it likely to resolve with conservative care with treatment, with bed rest, with medication, or is the pain most likely to be chronic?
12. Will the pain likely recur?
13. Under what circumstances will the pain recur?
14. What can I do to prevent the pain from recurring?
15. What specific instructions is it necessary for me to know in regards to relieving the pain and preventing it from recurring?
16. How can I relieve the pain and prevent it from recurring?
17. Should I address my weight, or weight reduction, exercise at home, or initially with supervision, physical therapy treatments and/or physical therapy supervision on a program of exercises, and/or physical therapy supervision on activities of daily living, or proper posture and body mechanics?
18. What type of medications may be necessary?
19. What are the risks and complications of such medication?
20. What happens if I get side effects from the medication?
21. What are my instructions in regard to the side effects?
22. What if the back pain doesn't improve?
23. What if I follow your instructions and the pain persists?
24. What is the next step in the course of diagnosis or treatment?
25. What is lumbar spinal stenosis?
26. How is lumbar spinal stenosis diagnosed?
27. Is this the same as a disc?
28. Is the treatment the same or different for a disc and/or lumbar stenosis?

2. Diagnosis: Herniated Disc

Questions that should be asked:

1. How can you be sure that the diagnosis is a herniated disc?
2. Can you explain to me, or show to me on a diagram or model the level and location of the disc? Is it more than one disc?
3. Are other diagnostic studies necessary?
4. What are the indications for other diagnostic studies?
5. If so, are they inpatient or outpatient procedures?
6. Are they invasive procedures?
7. What are the risks and complications of such procedures?
8. How is this condition treated?
9. Can it be treated conservatively and without surgery?
10. What are the indication for surgery?
11. How do you decide when surgery is necessary?
12. If the treatment is non-surgical and conservative, how long do we proceed with that treatment before we consider having to operate, or do some other form of treatment?
13. If surgical treatment is necessary, can you please explain to me what the nature of the procedure is, discuss the type of anesthesia that is necessary, what is the average length of time for hospitalization, what are the risks and complications of such surgery?
14. What if the surgical treatment does not relieve the pain?
15. What level of activity can I expect to return to after such surgery?
16. Are there any other things I can do to help myself to alleviate the pain, or prevent recurrence of herniated disc, such as weight loss, appropriate exercise, posture and body mechanics in regards to activities of daily living, and/or work activities?

3. Diagnosis: Arthritis of the Spine

Questions that should be asked:

1. Explain to me the definition of Arthritis of the Spine?
2. Is there more than one type of arthritis?
3. Is this arthritis of wear and tear or is this an inflammatory arthritis?
4. Is the arthritis likely to involve other parts of my body, and/or other joints, or is it localized specifically to my back?
5. How is it treated?
6. Are other diagnostic studies necessary?
7. What type of diagnostic studies might be needed, and are there risks and/or complications associated with those tests?
8. In regards to treatment, what medications are used?
9. How often do I see you and contact you in regards to follow up care, or reporting on my responses to medication, or reporting to you complications or side effects of medication?
10. Can arthritis of the back get progressively worse?
11. If so, what manifestations might it take?
12. What type of symptoms might I have?
13. What are the indications for me to seek further medical care?
14. If surgery is necessary, please describe to me the nature and the type of surgery, as well as the risks and complications.
15. Is it appropriate that the patient ask "Are you a back surgeon, do you operate on patients for this condition, how many operations have you performed, and what are your results in terms of risks and complications?"

4. Diagnosis: Pain in the Hips

Questions that should be asked:

1. Can you explain what arthritis of the hip means?
2. Am I likely to have arthritis in other joints?
3. Is it just in one hip, or both hips?
4. What type of studies, or x-rays are necessary?
5. What special diagnostic studies will be helpful?
6. Are any of these studies invasive (requiring injections or being stuck with needles)?
7. Once we are sure of the diagnosis, can we determine what caused the arthritis?
8. How is it treated?
9. Does it involve medications?
10. How long will I have to be on medications?
11. What are the side effects of the medication?
12. Will it be necessary for me to limit my weight bearing, standing or ambulation?
13. Will it be necessary for me to use support, such as a cane, crutches or a walker?
14. What happens if medical and conservative treatment does not relieve the pain?
15. Is surgery ever performed?
16. What type of surgery is performed?
17. What are the indications for surgery?
18. When do you decide to do such surgery?
19. What are the risks and complications of such surgery?
20. Once surgery is performed, does it ever have to be re-done, revised or does any artificial joint have to be replaced?
21. If surgery is done, what precautions will be necessary afterwards?
22. Will it be necessary to use a cane, crutches, or a walker?
23. Will physical therapy be necessary?
24. What restrictions would I have following such surgery?
25. Will the restrictions be temporary or permanent?
26. Will I have to modify my lifestyle?
27. Will it effect me in my current occupation?
28. Are you experienced in performing such surgery?
29. What is your experience in regards to risks and complications?

5. Diagnosis: Knee Pain (Arthritis)

Questions that should be asked:

1. Can you explain what arthritis of the knee means?
2. Is it just in one knee or both knees?
3. What type of studies, or x-rays are necessary?
4. What special diagnostic studies will be helpful?
5. Are any of these studies invasive (requiring injections or being stuck with needles)?
6. Once we are sure of the diagnosis, can we determine what caused the arthritis?
7. How is it treated?
8. Does it involve medications?
9. How long will I have to be on medications?
10. What are the side effects of the medication?
11. Will it be necessary for me to limit my weight bearing, standing or ambulation?
12. Will it be necessary for me to use support, such as a cane, crutches or walker?
13. What happens if medical and conservative treatment does not relieve the pain?
14. Is surgery ever performed?
15. What type of surgery is performed?
16. What are the indications for surgery?
17. When do you decide to do such surgery?
18. What are the risks and complications of such surgery?
19. Once surgery is performed, does it ever have to be re-done, revised or does any artificial joint have to be replaced?
20. If surgery is done, what precautions will be necessary afterwards?
21. Will it be necessary to use a cane, crutches, or a walker?
22. Will physical therapy be necessary?
23. What restrictions would I have following such surgery?
24. Will the restrictions be temporary or permanent?
25. Will I have to modify my lifestyle?
26. Will it effect me in my current occupation?
27. Are you experienced in performing such surgery?
28. What is your experience in regards to risks and complications?
29. Will I be able to play tennis or go skiing?

6. Diagnosis: Joint Pain

Questions that should be asked:

1. What is the cause of my joint pain?
2. Is it arthritis and , if so, what type of arthritis is it?
3. Is it inflammatory arthritis?
4. Is it likely to spread to other joints?
5. Are other diagnostic studies and tests necessary?
6. Are blood tests necessary?
7. Are special x-rays necessary?
8. Once all the test have been done, and a specific diagnosis is made, what is the usual type of treatment?
9. Is treatment always conservative?
10. Is surgery ever indicated?
11. If so, what type of surgery?
12. What are the risks and complications of such surgery?
13. Is it necessary to see an arthritis specialist or a rheumatologist?
14. Can you refer me to such a specialist?

7. Diagnosis: Fracture (Wrist)

Questions that should be asked:

1. Describe the fracture. Is it a "bad fracture"?
2. Are the bones out of place?
3. Is it a simple fracture (only two fragments of the bone), or is it more complicated with multiple fragments of bone?
4. Does the fracture require immobilization?
5. If so, please explain to me what that means.
6. Describe what type of a cast would be necessary. How long would I be in a cast?
7. How do I take care of a cast?
8. What problems are associated with wearing a cast?
9. Does treatment involve manipulation of the fracture? (does the fracture have to be set or treated in such a manner as to put it in a better position, or more anatomical position (that is a position close to the appearance of a normal bone))?
10. How is this treatment done?
11. Do I get an anesthetic and is it general or local?
12. Can the treatment be done in the office?
13. Does treatment require hospitalization?
14. If the fracture cannot be put in place by setting it, is surgical treatment needed?
15. How do you decide when to operate?
16. What type of surgery has to be done?
17. What are the risks and complications of such surgery?
18. Does it involve overnight stay in the hospital?
19. Does it involve follow up use of a cast?
20. After a cast is removed, do I need any further treatment?
21. Will physical therapy be necessary?
22. Are there any special exercises to do?
23. What should I do if I have increasing pain, or if the cast feels too tight, or if my fingers tingle or get numb?
24. Is it necessary to use a sling or other immobilization?
25. Can I exercise any of my joints?
26. How do I exercise them?

8. Diagnosis: Fractured Shoulder

Questions that should be asked:

1. Describe the fracture. Is it a "bad fracture"?
2. Are the bones out of place?
3. Is it a simple fracture (only two fragments of the bone), or is it more complicated with multiple fragments of bone?
4. Does the fracture require immobilization?
5. If so, please explain to me what that means.
6. Describe what type of a cast would be necessary.
7. How long would I be in a cast?
8. How do I take care of a cast?
9. What problems are associated with wearing a cast?
10. Does treatment involve manipulation of the fracture? (does the fracture have to be set or treated in such a manner as to put it in a better position, or more anatomical position (that is a position close to the appearance of a normal bone)?
11. How is this treatment done?
12. Do I get an anesthetic and is it general or local?
13. Can the treatment be done in the office?
14. Does treatment require hospitalization?
15. If the fracture cannot be put in place by setting it, is surgical treatment needed?
16. How do you decided when to operate?
17. What type of surgery has to be done?
18. What are the risks and complications of such surgery?
19. Does it involve overnight stay in the hospital?
20. Does it involve follow up use of a cast?
21. After a cast is removed, do I need any further treatment?
22. Will physical therapy be necessary?
23. Are there any special exercises to do?
24. What should I do if I have increasing pain, or if the cast feels too tight, or if my fingers tingle or get numb?
25. Is it necessary to use a sling or other immobilization?
26. Can I exercise any of my joints?
27. How do I exercise them?
28. How do I prevent stiffness of the shoulder?
29. When does an exercise program start?
30. Can I do it myself, is physical therapy or supervision necessary in order to prevent my shoulder from getting stiff?

9. Diagnosis: Fractured Hip

Questions that should be asked:

1. Please describe the type of fracture?
2. Is this a fracture in which the bones are not out of place?
3. Is this a fracture that can be treated without surgical intervention?
4. If surgery is necessary, what type of surgery is done?
5. Can the fracture be fixed by inserting a pin, nail, plate, screws or rod?
6. Is it necessary to replace any of the bone with an artificial hip?
7. What are the indications for such surgery?
8. What are the risks and complications of any surgery involving hip fractures?
9. What is the average length of stay in the hospital?
10. What is the average length of time one cannot bear weight?
11. What is the average length of time a patient has to use a cane, crutches or a walker?
12. Is physical therapy necessary?
13. What is the prognosis that is the outlook on complete recovery vs. further problems following such treatments?
14. Is it possible for something to happen to the hip following this injury that would require surgery or treatment in the future?
15. If an operation is necessary, when can it be done?
16. Can it be done as soon as possible?
17. If the physician states that surgery will not be done for a few days, the patient should inquire why isn't the surgery being done as soon as possible, and why isn't it being done within the next 24 hours?

10. Diagnosis: Fracture Knee

Questions that should be asked:

1. Please describe the kind of fracture that I have. If possible, please show me on a model, or show me on a drawing or on the x-ray.
2. Does the fracture involve the joint itself? (Interarticular)
3. Are any bones knocked out of place?
4. How is the fracture treated?
5. Can it be treated without surgery or operative intervention?
6. Is surgery necessary?
7. If so, what type of surgery would be done?
8. When would the surgery be done? How long will I be hospitalized?
9. What type of anesthesia will I have?
10. What are the risks and complications of such surgery in regards to the knee?
11. In regards to any other risks that may be imposed such as blood clots (thrombosis), drug reactions or allergies, and/or risks of anesthesia?
12. Following such surgery, is immobilization necessary?
13. Will I need to walk with some support, such as a cane, crutches or a walker?
14. If so, how long would this last?
15. Will I require therapy?
16. When would therapy start?
17. How long will therapy be required?
18. What is the prognosis? That is, will I have a "Normal Knee"; will I have an impaired knee?
19. Will the knee be stiff?
20. Will the knee be painful?
21. What are the future possible complications such as development of arthritis?
22. What is the likelihood of needing further treatment (operative treatment) for post traumatic or future arthritis?

11. Diagnosis: Sprained Ankle

Questions that should be asked:

1. Explain and define what occurs when an ankle is sprained.
2. How is this treated?
3. Do I need immobilization?
4. Do I need a brace?
5. Do I need a splint?
6. Do I have to walk with a cane, crutches or a walker?
7. Can I bear weight? How long will I be non-weight bearing?
8. How long will I be on partial weight bearing?
9. Do I need any therapy now or later?
10. How long will the therapy last?
11. Can I work?
12. Can I go to school?
13. Can I be active in sports?

12. Diagnosis: Internal Derangement of the Knee (Torn cartilage, torn meniscus) Questions that should be asked:

1. Please explain the problem. If possible, show me on a model what is torn, injured or stretched in the knee.
2. Are further diagnostic studies necessary?
3. Are any of those studies invasive?
4. Are there any risks or complications with those studies?
5. Will my insurance company pay for such tests?
6. What type of treatment is indicated?
7. If treatment is non-surgical, will I require physical therapy?
8. Will I require the use of crutches?
9. Will I be limited in activity?
10. Will I be restricted in my job, going to school or sports?
11. If so, how long will those restrictions last?
12. If surgery is necessary, what type of surgery is done?
13. Explain what arthroscopic surgery is.
14. Do you have a videotape showing an arthoscopic procedure so I can see what is done?
15. Does the surgery require hospitalization, overnight stay in the hospital, anesthetic?
16. Following surgery, what will be my instructions in regard to weight bearing, non-weight bearing, partial weight bearing, and use of cane, crutches or a walker?
17. Can I bear weight?
18. How long will I be non-weight bearing?
19. How long will I be on partial weight bearing?
20. Do I need any therapy now or later?
21. How long will the therapy last?
22. Can I work?
23. Can I go to school?
24. Can I be active in sports?

13 Diagnosis: Painful Feet (Bunions, corns, hammertoes, painful heels)

Questions that should be asked:

1. Please explain to me what is causing my problem.
2. Please explain if you can, what caused the problem to occur.
3. Is it related to the type of shoes I wear?
4. Can it be relieved with conservative care? That is, can it be relieved with appropriate shoes, appropriate arch supports or other orthotics, weight loss, limitations of activity, use of medications, use of injections, use of appliances on the toes?
5. If not, what type of surgery is performed?
6. Please explain the surgical procedures.
7. What are the risks and complications of such surgery?
8. Does it involve hospitalization?
9. Does it involve immobilization in bandages, casts or braces?
10. Does it involve partial weight bearing or no weight bearing?
11. Will I be required to use cane, crutches or walker?

14. Diagnosis: Neck Pain (Whiplash, arthritis, herniated disc)

Questions that should be asked:

1. Please explain the cause of my neck pain.
2. If in regard to an accident or trauma, such as a motor vehicle accident, what studies or diagnostic procedures are necessary?
3. If arthritis or herniated disc, what studies or diagnostic procedures are necessary?
4. How is this condition treated?
5. Is treatment conservative, or nonsurgical?
6. Are medications required?
7. What type of medications?
8. What are the side effects of the medications?
9. Will my insurance company approve diagnostic studies that you want to order?
10. Is physical therapy necessary?
11. Is immobilization, such as use of a brace, necessary?
12. What is the outlook or prognosis for this problem?
13. If surgery is performed, what type of surgery would be done?
14. Are you experienced in performing such surgery?
15. What are the risks and complications of such surgery?
16. How long does one go along with conservative treatment until decision is made to alter the treatment and perform such surgery?

15. Diagnosis: Bursitis (Various joints, shoulders, knees are the most common joints): Questions that should be asked:

1. Explain what bursitis is.
2. Can you show me on a picture or diagram where the bursa is?
3. What causes bursitis?
4. How will you treat it?
5. Can it be treated in the office?
6. Does it involve the use of medications?
7. What are the risks and side effects of those medications?
8. Does treatment involve injections, or use of needles?
9. If so, what are the risks and complications?
10. Will the treatment resolve the condition so it doesn't come back?
11. What are the chances of recurrence?
12. What are my instructions if the symptoms or pain recurs?
13. Will physical therapy treatments be required?
14. If so, for how long?
15. Is there anything I can do to prevent this condition from recurring?

16. Diagnosis: Rotator Cuff Disorder

Questions that should be asked:

1. How does the rotator cuff get hurt?
2. How do I know the rotator cuff is hurt?
3. What can I do to help the pain?
4. Are there specific exercises that I can do?
5. Are there other things I can do to help the injury heal?
6. What is a rotator cuff tear?
7. When is a MRI needed?
8. When is an arthrogram needed?
9. When is a CAT scan needed?
10. When is an ultrasound needed?
11. What treatment is there other than surgery?
12. When is surgery needed?
13. Will physical therapy help?
14. Will medication help?

Marvin R. Mishkin, M.D. Private Practice, Orthopedics St. Louis, MO