age related joint changes - exam 1 Flashcards
what are 3 names for age related joint changes?
degenerative joint disease (DJD)
osteoarthritis (OA)
spondylosis if multiple spinal levels
what region is the most common to find an age related joint change?
L4-S1
what is the more common cause of age related joint changes? what is a rare cause?
degenerative - typically in older individuals
acute tears - typically in younger individuals involving high shear forces
what are causes of age related joint changes?
prior trauma - changes structure and/or mechanics
age
genetics due to age related disc changes
other diseases (RA)
sedentary lifestyle with underloading
what structure is primarily involved with age related joint changes?
articular cartilage
what are the 5 synovial joint components?
- articular cartilage - frays, tears
- joint space - narrows
- fibrous capsule - thickens
- synovial membrane - decreased nutritions therefore:
- synovial fluid - decreased
when articular cartilage frays, blisters or tears, what happens to lead to periarticular tissue inflammation?
after fray blister or tear, joint space thins and narrows –> bone is overloaded which leads to greater bony stress –> fibrous capsule slackens eventually leading to thickening and stiffness –> synovial membrane produces less synovial fluid and nutrients –> periarticular tissue inflammation (ligaments, capsule, mm)
in age related joint changes, what is persistent P! and inflammatory response partly due to? (4)
stress on other tissues like bone
increased local nociceptor sensitivity for greater P! transmission fostering inflammation
local production of nitrous oxide leads to more interstitial inflammation and excess collagen
blood being released from bone marrow
what are the symptoms to recognize age related joint changes in the lumbar region?
gradual onset of LBP
P! w prolonged positions, particularly standing, possibly sleeping depending on position (squeezes out synovial fluid w/o allowing refilling)
morning stiffness or AFTER prolonged positions < 30 min
P! & limitation while standing (prolonged) and walking or lying on stomach
possible paresthesias - compression on spinal n.
some movement helps but too much makes it worse –> hypermobility
what is the directional preference for someone with age related joint changes ?
flexion
what would the PT expect to see if someone has age-related joint changes in the lumbar region?
-observation/ROM?
-combined motions?
-resisted testing?
-stress tests
-neuro test
observation:
possibly forward bent in standing/walking
ROM:
P! w ext, ipsilateral SB, contralateral RT
one side > the other, but may be bilateral
capsular pattern of restriction
CM:
consistent block often into an ext quadrant OR opposing quadrants consistently blocked
resisted:
depends on acuity
stress tests:
likely P! w compression, particularly if added while in ext, ipsilateral SB or contralateral RT
PA glides and unilateral torsion likely P!ful
distraction relieving if acute
neuro:
often (-) but could be (+) for radiculopathy if spurring creates stenosis on spinal nerve
what would the PT expect to see if someone has age-related joint changes in the lumbar region?
-accessory motion?
hypomobility
early S&S of age-related joint changes:
- capsular pattern
- hypermobility
- Rx
- likely seen in PT?
- yes, if past trauma
- yes due to narrowing if no past trauma
- POLICED —-> JM for closed-pack position MET
- no not common
intermediate S&S of age related joint changes:
- capsular pattern
- hypermobility
- Rx
- likely seen in PT?
- yes with firm end feels
- no, hypomobile
- JM and MET to involve adjacent joints for ROM
- more likely to show up for PT
late/advanced S&S for age related joint changes:
- capsular pattern
-hypermobility
- Rx
- likely seen in PT?
- no with bony end feels due to osteophytes
- no, hypomobile
- JM and MET with greater focus on adjacent joint motions
- yes!
