Orthopedic surgery deals with the problems of the spine and the extremities. An orthopedic surgeon diagnoses and treats patients whose musculoskeletal problems include arthritis, trauma and congenital deformities. He or she also works with patients who have traumatic and overuse injuries. Using both surgical and non-surgical means, the orthopedic surgeon will treat injuries and degenerative problems of the spine and extremities, such as hands, feet, knees, shoulders and elbows. Education, after a four year pre-med or science college degree, requires four additional years of medical school, an internship year and four years of residency in a teaching hospital. Some orthopedic doctors continue their education with another year or two of fellowship trainings in order to sub specialize.