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Gerontology Mod09

Orthopedic Considerations

QuestionAnswer
Most common postural change with age "senile posture" Forward Head Posture (FHP) Rounded shoulders Increased thoracic kyphosis Decreased lumbar lordosis Flexed hips and knees
When is the greatest amount of bone density lost with osteoporosis? Within the first 5 years of menopause
What is estrogen's effect on osteo cells? Reduces the lifespan of osteoclasts Lengthens the lifespan of osteoblasts
What is secondary osteoporosis? Bone loss associated with chronic medical conditions, nutritional deficiencies, and medications
What modifiable risk factor doubles the risk of an osteoporotic fracture? Smoking
What chronic medical problems can cause osteoporosis? RA Diabetes Hyperthyroidism Addison's Liver disease
What kyphotic deformity is associated with osteoporosis? Anterior compression wedge fractures of the vertebral bodies. Multiple fractures form a curve known as a "Gibbus" or "Dowager's hump"
Signs and symptoms of a wedge fracture Loss of height Distended abdomen Stooped posture Only 1 out of 4 women with VCF have symptoms
Drug therapy to treat osteoporosis Hormone replacement therapy Bisphosphonates decrease osteoclast activity Selective estrogen receptor modulators (SERMs)
Recommended doses of Calcium and Vitamin D Ca = 1000-1500 mg Vitamin D = 400-600 IU per day Vitamin D slows down bone loss, increases absorption of Ca in the GI, and boosts mineralization
Medical interventions for vertebral fractures Vertbroplasty - cement injected into the vertebral body Kyphoplasty - balloon tamp inserted prior to injecting cement Significant relief in pain in 90-95% of pts
Interventions for kyphotic posturing Proprioceptive and neuromuscular reeducation Kyphothosis or Spino-Medbrace Resistive exercises
Kyphotic posture has been linked to a propensity to __________ in osteoporotic individuals. fall
During the acute phase of vertebral fracture PT should focus on Exercises to reduce muscle guarding around fx site Deep relaxed breathing to decrease muscle guarding
How long does it take for changes in BMD to appear due to exercise? Measurable changes may only be apparent years later
Type of exercises to increase BMD Site-specific Heavy loading with few repetitions and high strain
Flexion vs Extension exercises 89% of flex group experienced VCF 67% in non-exercise group 53% in flex and ext group 16% in ext group
T-Score for osteopenia -1.0 - -2.5 osteopenia lower than -2.5 osteoporosis
Osteomalacia Bone disorder caused by a failure of normal calcification of bone matrix Softening of bones due to lack of vitamin D Dysfunction with the ability to metabolize vitamin D
Most common cause of osteomalacia in older adults Inadequate intake of vitamin D Lack of exposure to sunlight GI malabsorption Extensive burns Chronic diarrhea Medications - i.e. Dilantin
Paget's disease (Osteitis Deformans) Progression of 3 distinct stages 1) Osteoclastic 2) Osteoblastic 3) Sclerotic Osteoblast construct abnormally large and deformed bone
Locations most often affected by Paget's disease Pelvis Long bones Spine Reibs Sternum Cranium
Symptoms of Paget's Disease Most patients have no symptoms Insidious onset and slow progression Bone and joint pain or stiffness Bowing of femur and tibia and thoracic kyphosis Enlarged head Waddling gait pattern Acute px may indicate fx
Avascular Necrosis (AVN, Osteonecrosis) Lack of blood supply resulting in death of bone tissue in absense of infection
Joints most likely to be affected by AVN Hip* - most common Shoulder Knee Hand Foot Ankles
AVN is associated with Long-term corticosteriod use Excessive alcohol intake DM Obesity Gout Cushing's disease
Most common locations of OA CMC Knees Hips
3 Stages of RA 1) Synovium swelling, stiffness, erythema, joint effusion 2) Rapid division and growth of cells, thickening of synovium 3) Release of enzymes from inflamed cells, development of vascular granulation tissue (pannus)
PT interventions for RA Joint protection techniques Passive mobilization Postural exercises Strengthening exercises at all stages of RA
Cervical RA symptom location Usually posterior and mid-cervical
Cervical spondylosis Degernerative changes in cervical spine Loss of disk height Reduction in spinal ROM Radiculitis in UE (25% of patients)
Vertebral artery syndrome (VAS) signs and symptoms Signs induced by head rotation compressing posterior inferior cerebellar artery Vertigo Dizziness Tinnitus Blurred Vision Nausea Nystagmus Ataxia
Possible causes of VAS osteophytes from OA disc degeneration and narrowing of intervertebral space FHP
Ossification of PLL symptoms Limits cervical flex May cause radiculopathy
PT treatments for ossification of PLL MHP Cervical traction Avoidance of sedentary activites Postural exercises Stretching ROM PREs
Degenerative disc disease results in _______(3) Reduces foraminal cross-section due to inward bowing of annulus and ligamentum flavum Loads placed on longitudianl ligaments and outer-most annulus that stimulates osteoblastosis Results in osteophytes or disk-osteophyte formation
Spinal Stenosis Initial spinal instability with aging is caused by dehydration of intervertebral disc Addition of bone occurs at periosteal surfaces resulting in osteophyte formation causing stenosis
What is the most common cause of neurologic leg pain in older adults? Stenosis
What leads to compression of the neural elements in the lumbar spine? Posterior osteophytosis Severe disk narrowing bulging of annulus fibrosis and ligamentum flavum
What are the most common causes of pain in active geriatric populations? Impingement syndrome Rotator cuff pathology
Tendonitis Inflammation of the tendon sheath (not the tendon itself)
Bursitis Inflammation of the subacromial bursa
Tendonosis Intra-tendonous disease, such as intra-substance degeneration or tearing
OA of the shoulder occurs more commonly than shoulder bursitis in the older population. T/F False. Bursitis is more common than OA
Symptoms of bursitis Palpable tenderness in the area of the inflamed bursa Pain with movement of muscle affected by the bursa Symptom relief with rest
PT interventions for bursitis Avoid painful movements until pt can tolerate isometric exercise Perform exercises above and below painful arc Modalities for pain
Rotator cuff tears are often atraumatic in older adults. T/F True
In the case of a RTC tear with no substantial weakness or functional disability what is recommended? PT and anti-inflammatory medication for 6 weeks to 3 months
Capsular pattern for the shoulder ER is most limited, ABD, FLEX, IR limited
Reverse TSA are indicated for Complete RTC tear Previous TSA that failed
Colle's Fracture Distal radius fx with dorsal and radial displacement of the wrist and hand "Dinner fork" deformity
OA is common in what joints of the hand? IP and CMC joints of the thumb
Dupuyten's contracture (definition, age of onset) Longitudianl bands of palmar aponeurosis undergo fibrosis, MCP and PIP joints flexed Average age of onset 60 y.o.
Swan-neck deformity DIP flexes PIP extends
Boutonniere deformity DIP extends PIP flexes
3 possible causes of posterolateral hip pain along greater trochanter Trochanteric bursitis Gluteal insertion tendinopathy Component loosening in THA
Results of platelet rich plasma (PRP) injections into joints Enhanced neovascularization Accelerated healing process Promotion of better scar tissue quality
95% of hip fracture occur at what 2 locations? Intertrochanteric Femoral neck
What is the leading cause of disability in the US? Knee OA
What is the strongest single predictor of functional limitations in patients with knee OA Quadriceps weakness
What joint deformity in the foot is linked to diabetes? Diabetic osteoarthropathy, aka Charcot joint arthropathy
What joint deformities occur in the foot from RA? Hallux valgus Hallux rigidus Hammer toes Claw toes Mallet toes Lateral subluxation with lateral deviation
Created by: jpwittman