Orthopedic conditions and treatment patterns among unhoused urban patients: a street medicine study

BACKGROUND: Unhoused individuals experience a high burden of musculoskeletal (MSK) conditions but often face barriers to traditional healthcare. Street Medicine Phoenix (SMP) is a mobile healthcare initiative composed of medical students and physicians providing free medical screenings to this population. This study aims to characterize the prevalence, demographic distribution, and treatment of orthopedic conditions among unhoused patients in an urban street medicine program. METHODS: This retrospective observational study analyzed patient encounters from August 2023 to August 2024, collected by SMP in Phoenix, Arizona. Orthopedic conditions were identified through review of Subjective, Objective, Assessment, and Plan (SOAP) notes from 1,193 adult patient encounters. Diagnoses were categorized into clinical MSK types. Treatments included pharmacologic and non-pharmacologic interventions. Descriptive statistics, Mann-Whitney U tests, and chi-squared tests were used to assess differences by age and sex. Results are reported with 95% confidence intervals. RESULTS: Of 1,193 encounters, 228 (19.1%) involved orthopedic issues. The mean age of patients with MSK conditions was 50.2 years (95% CI: 48.9–51.5); 33.6% identified as female. The most common diagnoses were trauma-related injuries (35.1%; n = 80), joint pain (29.4%; n = 67), and chronic pain (21.9%; n = 50). A statistically significant age difference was observed between patients with trauma and arthritis (p < 0.05). Oral NSAIDs were the most common treatment ((19.3%; n = 59), followed by wound care kits (13.4%; n = 41), acetaminophen (11.5%; n = 35), and bracing (10.5%; n = 32). No significant differences in treatment rates by sex were identified. CONCLUSIONS: Orthopedic conditions are prevalent among unhoused individuals and represent a major source of morbidity. Mobile care models like SMP provide effective, immediate treatment using accessible modalities. Low-barrier treatments—particularly oral NSAIDs and durable medical equipment (DME: defined as boots, braces, walkers, crutches etc.)—represent feasible and effective interventions that improve pain and function in vulnerable populations with limited access to traditional care pathways. This study underscores the need for scalable MSK interventions and provides a data-driven framework for improving orthopedic care among unhoused populations. TRIAL REGISTRATION: Not applicable.