Orthopedic medicine focuses primarily on the musculoskeletal system, which includes the bones, joints, ligaments, tendons, and muscles. Yes, orthopedic doctors do treat nerve pain, but only when it originates from a structural or mechanical issue within this system. Their expertise involves diagnosing and treating conditions where surrounding tissues physically compress or irritate a nerve, essentially addressing the “plumbing” problem causing the nerve signal disruption. This approach contrasts with specialties that focus on the nerve tissue itself or the central nervous system.
The Orthopedic Focus on Nerve-Related Pain
The orthopedic specialty addresses nerve pain, often called radiculopathy or neuropathy, when it arises from mechanical interference. This means the doctor focuses on the spine, joints, and limbs, which are the structures that can physically impinge upon nerves as they exit the spinal column or pass through constricted tunnels in the body. Their training centers on restoring the proper relationship between bone and soft tissue to alleviate pressure. Orthopedic surgeons are skilled at procedures that decompress nerves by altering the surrounding musculoskeletal anatomy.
An orthopedic doctor’s role is to correct the structure causing the nerve irritation. For instance, a nerve root may be pinched as it leaves the spine because a piece of disc material or a bone spur is taking up space. The orthopedic approach is to relieve that pressure by removing the offending material, thereby treating the mechanical problem that generates the nerve symptoms.
Identifying Structural Causes of Nerve Pain
Orthopedic doctors treat nerve pain caused by conditions such as a herniated or bulging intervertebral disc, which can press directly on a spinal nerve root. Another common structural cause is spinal stenosis, where the narrowing of the spinal canal or neural foramina compresses the nerves or spinal cord. Degenerative changes like bone spurs (osteophytes) can also narrow the space available for nerves, leading to pain and neurological symptoms.
In the extremities, orthopedic doctors frequently manage entrapment neuropathies like Carpal Tunnel Syndrome in the wrist or Cubital Tunnel Syndrome at the elbow. These conditions occur when soft tissue structures, such as ligaments or fascia, compress a peripheral nerve as it travels through a narrow passage. Diagnosis involves a thorough physical exam combined with specific imaging and nerve tests to confirm the structural source of the compression. Orthopedists use diagnostic tools such as X-rays, Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scans, and Nerve Conduction Studies (NCS) or electromyography (EMG) to assess the compression and nerve function.
Conservative and Surgical Treatment Options
Orthopedic treatment for nerve pain generally follows a stepwise approach, starting with the least invasive methods. Conservative treatments are the first line of defense and include nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation around the nerve. Physical therapy focuses on strengthening muscles, improving flexibility, and modifying activities to take pressure off the irritated nerve. Bracing or splinting, such as a wrist splint for carpal tunnel syndrome, can also immobilize the area and reduce mechanical stress.
For persistent pain, targeted interventions like corticosteroid injections may be used to deliver powerful anti-inflammatory medication directly to the site of nerve compression. Examples include an epidural injection in the spine or a joint injection near the affected nerve. If conservative management fails to provide sufficient relief after several weeks to a few months, or if a patient experiences a progressive neurological deficit, surgical options are considered. Surgical procedures aim to decompress the nerve by physically removing the structure causing the pressure.
Surgical Interventions
Specific surgical interventions performed by orthopedic surgeons include a discectomy, which removes the portion of a herniated disc pressing on a nerve root. Another procedure is a laminectomy, which involves removing part of the bony arch of the vertebra to create more space in the spinal canal. For peripheral nerves, procedures like a carpal tunnel release involve cutting the ligament that is compressing the nerve. These surgeries are performed to restore nerve function and are often highly effective in resolving symptoms caused by structural compression.
When Another Specialist is Needed
The limits of orthopedic care are reached when the nerve pain is not caused by a mechanical or structural compression that can be surgically fixed or decompressed. In these scenarios, referral to a different specialist is necessary for appropriate diagnosis and treatment. A Neurologist is the appropriate specialist when nerve pain stems from systemic diseases affecting the nerve tissue itself, such as generalized peripheral neuropathy caused by diabetes or autoimmune disorders.
Neurologists focus on the health of the nervous system, including the brain, spinal cord, and peripheral nerves. They manage conditions like multiple sclerosis or nerve damage from toxins or nutritional deficiencies. Pain Management Specialists may also be involved, particularly for chronic, complex pain conditions like Complex Regional Pain Syndrome (CRPS) or when interventional pain procedures are needed. While orthopedists treat the structure, the neurologist treats the function and health of the nerve tissue itself.