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Bone is a biphasic connective tissue consisting of an inorganic mineral phase and an organic matrix phase. The hardness of bone allows it to provide several specialized mechanical functions: the protection of internal organs, the scaffold that provides points of attachment for other structural elements, and the levers needed to improve the efficiency of muscle action. In addition, bone serves two biologic functions: a site for hematopoietic activity and a reservoir of minerals needed for metabolic interchange.

Skeletal trauma, for the subject of discussion, can be divided into three major groups of injuries to the musculoskeletal system: A fracture, by definition, is a disruption in the continuity of cortical and/or cancellous bone. A dislocation is a disruption of the normal articulating anatomy of a joint. Dislocations can either be a complete disruption of the normal anatomy or a partial dislocation, in which case the term subluxation is used. A fracture/dislocation is a fracture occurring in or near a joint that results in a subluxation or dislocation of the joint.

Because of their relative rarity, as compared to other types of more typical infections, musculoskeletal infections can prove to be extremely difficult to diagnose and treat. Unrecognized infections can be limb threatening and even potentially fatal if not recognized and treated. The most important aspect of caring for patients with a musculoskeletal infection is to come to a timely diagnosis. When a timely diagnosis is made, most musculoskeletal infections can be effectively treated and the morbidity minimized. Open fractures are an extremely common occurrence in orthopedics, and specific attention is given to this topic. In general, appropriately treated open fractures can typically prevent the establishment of any type of chronic musculoskeletal infection or osteomyelitis.

Both benign and malignant tumors (neoplasms) may arise from any mesenchymal soft tissue or bony tissue of the extremities, pelvis, shoulder girdle, or the axial skeleton. All tumors arise from one of the different histologic types of tissue that comprise the musculoskeletal system: bone (osteoid-forming tumors), cartilage (chondroid-forming tumors), and muscle and the fibrous connective tissue (soft tissue tumors). Only rarely do tumors arise from the arteries or nerves.

This statement has been presented in many different ways; but it is critically important that this central fact be recognized if one is to successfully diagnose and treat disease in this age group. Even within this rather broad range of ages there are dramatic differences among specific subsets: neonate, child, and adolescent.

The emphasis presently placed on physical fitness in society in terms of overall health is at an all-time high. Participation in both organized and recreational sports has escalated during the past several decades as a result. This increase in participation has lead to an emphasis on treating injuries associated with sporting activities. The advances within medicine regarding the diagnosis of these injuries, such as magnetic resonance imaging (MRI), as well as arthroscopy for their treatment, has improved results only to focus more attention within this field. A number of skilled physicians and other health professionals have developed interests regarding the specific care of athletes. The goal of sports medicine as a subspecialty is the prevention of injury, diagnosis and treatment of athletic injury, and returning athletes to preinjury activity with no acute or long-term sequelae. The purpose of this chapter is to focus on the biologic tissues involved in sporting injuries, highlighting the patterns in which they are injured. An overview then follows regarding the evaluation and treatment principles as they relate to the management of athletes and sport-specific injuries.

The majority of adults are, at some point in their life, affected by disorders of the spine. Every physician should have a basic knowledge of the potential pathology and be able to distinguish a serious problem from a minor condition. Disastrous sequelae such as paralysis can occur if this differentiation is not appreciated. This chapter first addresses the cervical spine and then presents the lumbar spine. In each area, the history, physical, and appropriate diagnostic studies are reviewed. Next, a standardized protocol or algorithm for the diagnosis and management of these patients is described. Finally, several of the most common conservative treatment modalities is presented with special attention given to their efficacy.

The shoulder joint, as it is commonly called, is not a single joint but a complex arrangement of bones, ligaments, and musculotendinous units that is more aptly called the shoulder girdle. The primary role of the shoulder girdle is to provide a tremendous range of motion for positioning the upper extremity in space. The shoulder girdle also provides power and support for the upper extremity throughout and at the extremes of the range of motion. Many shoulder girdle problems stem from overuse injuries during activities such as pitching a baseball or serving a tennis ball that exploit both the power and range of motion of the shoulder girdle. This chapter reviews the anatomy of the shoulder girdle and provides an approach to evaluating and treating common shoulder problems.

Although the elbow is rarely given top priority in teaching or training situations, its function is critical to upper extremity use. In looking at the arm as a unit, the tremendous range of motion of the shoulder can be thought of positioning the hand on the outer surface of a sphere. It is the flexion, extension, pronation, and supination of the elbow and forearm that allow positioning of the hand within that sphere, thus creating the ability to function throughout a huge volume of space surrounding a person. When elbow and forearm function are compromised by pain, injury, or loss of motion, significant disability can result. The goals of this chapter are to present the elbow’s functional anatomy, describe how to evaluate this region, and present an approach to diagnosis and treatment of common elbow problems.

The human hand is one of the most important interfaces of a person’s body with the outside world. It allows us to touch, feel, manipulate, and modify our environment. Its cortical representation in the brain is nearly as large as the rest of the musculoskeletal system combined. Loss of hand function can have devastating effects on a person’s ability to work or perform activities of daily living. Unfortunately, because of its constant use and its position at the forefront of human activity, it is frequently affected by trauma and other disease processes. Nearly all physicians will see patients with hand problems, so some familiarity with these processes and basic hand evaluation is very important.