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Orthopaedic specialists are doctors who are experts in managing bones, joints, and muscles. For children with DMD, orthopaedic specialists can help asses, advise, and plan for any changes or issues in these areas.
Below is a list of frequently asked questions about orthopaedic specialists and your appointments with them. Click on each question or row to read more. If you have further questions, please speak with your neuromuscular care team at your local clinic or hospital.
An orthopaedic specialist is a doctor who is an expert on bones, joints and muscles. They will perform an assessment and provide, advice and a plan to manage stiff joints, tight muscles, curvature of the spine, broken bone/s, skeleton changes or pain.
An orthopaedic specialist is also a surgeon and in some cases they may recommended surgery to improve your child’s comfort, physical ability or well-being.
An orthopaedic specialist may become an important part of your medical team for support in managing challenges related to your joints, bones and muscles.
In particular, you may work with an orthopaedic specialist around managing:
Muscle or joint stiffness
With respect to muscle or joint stiffness, most young people with DMD will have a daily program of stretching and/or night splints from their physiotherapist or occupational therapist. However, when stiffness gets to a point where more input is needed, it is also useful to be reviewed by an orthopaedic specialist.
In your appointment, they may ask how the stiffness impacts on physical abilities (such as play, walking, sitting), comfort and may physically assess the area. Your specialist’s advice will match your child’s individual picture.
Monitoring the spine for curavture
Young people with DMD are at risk of developing a curvature of their spine as they grow older. Their therapy team will monitor for this when they come for their clinic reviews.
If it is suspected that a curve is developing, they will refer for a spine x-ray and review with the orthopaedic specialist.
Fracture (broken bone)
A broken bone, or fracture, may occur from either a fall or other traumatic event or as a side-effect of medication. In both these cases, consultation with an orthopaedic specialist is required to build a management plan and to monitor towards recovery.
You will need to be referred to see an orthopaedic specialist.
If a person with DMD would benefit from seeing an orthopaedic specialist, their neurologist will refer them to a service that is experienced in working with neuromuscular conditions.
Often the need to see an orthopaedic specialist will be flagged by the neurologist, physiotherapist or occupational therapist after a physical assessment has been conducted.
The most common reasons that a person with DMD will be referred to an orthopaedic specialist includes:
Usually a neurologist, GP, physiotherapist or occupational therapist will make the recommendation to see the specialist in response to information provided by families and the physical assessment they conduct during an appointment.
No, initially the referral is made to an orthopaedic specialist to seek their opinion and to inform a plan around non-surgical management (such as night splints and stretching programs).
If surgery is recommended, a plan for the direction of your child’s care occurs in close consultation with their family including their priorities, concerns and goals.
Often the orthopaedic specialist will require an x-ray to ensure they have all the information they need about your child’s bones in order to provide the best advice. An x-ray provides extra information that cannot be gained from a physical assessment alone.
If you have concerns about the x-ray, perhaps risks related to it or how your child will cope with it, be sure to get in touch with your therapy team so they can help you and your child prepare.
Orthopaedic clinics are very busy, so it is a good idea to think about your main concerns and questions for the specialist before you arrive. You may wish to write a list that you and your orthopaedic specialist can work through.
Be sure to attend an x-ray if requested by the doctor before your orthopaedic appointment. If an x-ray was done at a different centre, bring the x-ray film (it might be on a USB or CD).
Bring any splints you may have been using already.
This will vary a little from place to place but in general, the following stages will likely occur:
This will depend on a number of factors such as:
If they are being monitored (meaning if the orthopaedic specialist is keeping an eye on how they are going over time) they may only be seen once a year.
If the specialist is intervening (such as planning or has done surgery) or things are changing quickly, they will see them much more regularly.
If in doubt, this is a good question to ask the orthopaedic specialist during the consultation or to ask the clinic’s nurse co-ordinator after the appointment.