age related joint changes - exam 2 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?
C5-7
what is the most common cause of disability in the US?
what percent of adults > 55 have this?
age related joint changes (1 in 5 adults)
80%
what two joints are the most common sites for age related joint changes?
hip and knee
if you’re an athlete, can you assume your body will experience age related joint changes more than other people?
no
physical activity is protective - trauma would be the only thing that could progress age related joint changes
what structure is primarily involved with age related joint changes?
articular cartilage
why is articular cartilage not capable of producing an inflammatory response?
so what is the source of inflammation?
it is avascular
bone on bone decreases symptoms because it has vascularity which creates inflammation response which helps heal
the bone (because of above)
articular cartilage is resistant to _______
bone is resistant to ______
compression
tension
why does the articular cartilage depend diffusion?
thrives on intermittent compression and decompression with gliding
what is the hydroelastic capability in articular cartilage?
with quicker compression from muscle activity or WB, the quicker it’s pushing back
fluid doesn’t like leaving quickly - need increase in synovial fluid
why is a closed pack position important in articular cartilage?
it allows for full ROM which is needed to maximally get nutrients in and waste out
what is the more common cause of age related joint change? in what population?
degenerative articular cartilage - typically in older adults
what are the 5 synovial joint components?
- articular cartilage
- joint space
- fibrous capsule
- synovial membrane
- synovial fluid
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)
what is the patient likely to tell you if they have age related joint changes in the cervical region?
- gradual onset of neck P! (thickened capsule)
- P! w prolonged positions (FHP or sleeping)
- morning stiffness or after prolonged positions < 30 minutes
- P! and limitation looking in blind spots or looking up
- possible paresthesias - narrowing of foramen compressing spinal n.
- some movement helps but too much makes it worse -
what would the PT expect to see if someone has age-related joint changes in the cervical region?
-observation/ROM?
-combined motions?
-resisted testing?
-stress tests
-neuro test
OBSERVATION/ROM
- FHP
- ROM painful and limited
- pain with extension and ipsilateral SB and RT
- typically one sided
- a capsular pattern of restriction (hypo)
-combined motions: consistent block (hypo)
-resisted testing/MMT: depends on the acuity
-stress tests: PA glides P! with compression, distx relieving
-neuro tests: often (-). BUT could be + for radiculopathy if stenosis on spinal nerve (spurlings)
what would the PT expect to see if someone has age-related joint changes in the cervical region?
-accessory motion?
-special tests?
-hypomobility
-spurlings & CPR (+)
what are the causes of age-related joint changes?
prior trauma
age
genetics
disease
sedentary lifestyle with underloading (not enough load is just as bad as too much load)
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!
why do deeper defects heal better than superficial lesions?
it hits the bone which is vascular –> inflammatory response to help healing
why do superficial lesions cause more pain?
type I collagen fills in where type II should be going –> type I collagen resists tension but it needs to resist compression instead (type II collagen) –> this insufficient patch creates a short term fix (poor outcomes)
what is the greatest focus in PT Rx for degenerative changes?
improving integrity of cartilage and mobility (JM) (sponge example –> proper MET exercises)
what do you need to make sure of when prescribing MET for age-related joint changes?
proper amount of exercises and reps
DO NOT overload or provoke these symptoms
