Musculoskeletal conditions Ahmad Osailan

Common changes in musculoskeletal system due to aging Dehydration of disc causes reduction in total height by 1 cm in 10 yrs Muscle weakness contributes to fatigue, weakness, and reduced activity. The foot arches become less pronounced, causing a slight loss of height. Hip and knee joints may begin to lose joint cartilage (degenerative changes). The finger joints lose cartilage and the bones thicken slightly. Finger joint changes are more common in women.

OSTEOPOROSIS Osteoporosis is a bone disease characterised by reduction of bone tissue relative to volume of anatomical bone. This increases susceptibility to fracture.

OSTEOPOROSIS In osteoporosis, the bone is of normal size, but contains less bone tissue, with no change in ratio of mineral content to organic material. In osteomalacia, the amount of bone can be normal or increased, but has reduced mineral content

OSTEOPOROSIS Most common complications and fractures resulting from osteoarthritis: Hip fracture, Vertebral fracture, distal radial fracture humeral neck fracture Postural deformities

Osteoporosis Predisposing factors: – Sedentary living – Inadequate estrogen – Underweight – Low calcium intake

OSTEOARTHRITIS Common in geriatric population Primary generalised OA –affects hands with formation of Heberden’s & Bouchard’s Nodes Mostly affects the knees, hips and spine Pain, deformity and decreased mobility

Osteoarthritis Stiffness, tenderness, crepitus and enlargement develop. Deformity, incomplete dislocation and synovial effusion may eventually occur. Treatment: rest, heat, ice, anti inflammatory drugs, decrease wt. if indicated, injectable corticosteroids, surgery.

Clinical Manifestations (osteoarthritis) Heberden’s Nodes – Appears in both men and women – Located at the distal interphalangeal joints – Appears on both hands – May be painful and red – Tend to be familial and of cosmetic concern – Feel hard and cause tenderness when palpated

Heberden’s Nodes

Clinical Manifestations (continued) Bouchard’s nodes – Same manifestations as Heberden’s nodes except: Bouchard’s nodes are located at the proximal interphalangeal joints

Spine OA Degenerative disease of the spine can involve the apophyseal joint intervertebral disks paraspinous ligaments. Spondylosis refers to degenerative disk disease.

Spine OA The diagnosis of spinal OA should be reserved for patients with involvement of the apophyseal joints and not only disk degeneration. Symptoms of spinal OA include localized pain and stiffness Nerve root compression by an osteophyte blocking a neural foramen prolapse of a degenerated disk or subluxation of an apophyseal joint may cause radicular pain and motor weakness.

Degenerative changes in the spine- Definitions: Apophyseal joint- the joint around a bone that has no independent ossification Spondylosis- ankylosis (stiffening) of the vertebrae (this term is often used very generally to refer to any degenerative back problem) Spondylolysis- degeneration of the articulating part of the vertebrae (the classic OA change) Spondylolisthesis- forward movement of the body of one of the lower vertebrae on the vertebrae below it Spondylitis- inflammation of one or more of the vertebral bodies (infection [TB] or inflammatory disease [RA])

Osteoarthritis- Risk Factors Age Decreased muscle strength Obesity Possible genetic risk Early in disease process, OA is difficult to dx from RA Hx of Trauma to joint

OA- Signs and Symptoms Joint pain and stiffness that resolves with rest or inactivity Pain with joint palpation or ROJM Crepitus in one or more joints Enlarged joints Heberden’s nodes enlarged at distal IP joints Bouchard’s nodes located at proximal IP joints

What to assess for: ESR, Xrays, CT acans Degree of functional limitation Levels of pain/fatigue after activity Range of motion Proper function/joint alignment Home barriers and ability to perform ADLs

REHABILITATION INTERVENTIONS Patient education Rest, Exercise, Ergonomics Physical Modalities Orthosis, Assistive devices & Ambulatory aids Environmental modifications Surgery & post-surgery rehabilitation

Rheumatoid Arthritis Chronic, systemic, progressive inflammatory disease of the synovial tissue, bilateral, involving numerous joints. Synovitis-warm, red, swollen joints resulting from accumulation of fluid and inflammatory cells. Classified as autoimmune process Can cause severe deformities that restrict function

RA- Risk Factors Female gender Age years Genetic predisposition Epstein Barr virus Stress

RA – Signs and Symptoms Joints- bilateral and symmetric stiffness, tenderness, swelling and temp. changes in joint. Pain at rest and with movement Pulses- check peripheral pulses, Edema- observe, location of edema. ROM, muscle strength, mobility, atrophy Anorexia, weight loss Fever-

Complications of RA Joint deformity Vasculitis Cervical subluxation

Gouty Arthritis Very painful joint inflammation, swollen and reddened Primary-Inborn error of uric acid metabolism- increases production and interferes with excretion of uric acid Secondary- Hyperuricemia caused by another disease Excess uric acid – converted to sodium urate crystals and precipitate from blood and become deposited in joints- tophi or in kidneys, renal calculi Treatment: Meds- colchicine, NSAIDS, Indocin (indomethacin), glucocorticoid drugs, Allopurinol, Probenecid-reduce uric acid levels Diet- excludes purine rich foods, such as organ meats, anchovies, sardines, lentils, sweetbreads,red wine Avoid diuretics- may precipitate attacks

Rehabilitation Rest, during day- decrease wt. bearing stress. ROM- maintain joint function, exercise –water. Ultrasound, diathermy, hot and cold applications Surgical- Synovectomy, Arthroplasty, Total hip replacement.