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Geriatrics > Aging and the Musculoskeletal System > Flashcards

Aging and the Musculoskeletal System Flashcards

1
Q

What structures are involved in the musculoskeletal system?

A

Bones and joints
Muscles
Soft tissue - ligaments, tendons
Nervous system - PNS
Circulation

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2
Q

What do bones do?

A

Gives shape and support to the body
Protect internal organs
Major muscles are attached and help them move
Blood cells are formed in bone marrow
Calcium and phosphorous are stored in the skeleton and make bones hard.
Metabolic functions
- mineral storage
- fat storage
- hormone production (osteocalcin)
- growth factor

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3
Q

When does bone strength peak?

A

20-30s

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4
Q

What are the types of muscles?

A

Smooth - internal organs, blood vessels, involuntary, controlled by ANS
Skeletal - voluntary
Cardiac - heart, involuntary, controlled by ANS

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5
Q

What are the types of skeletal muscle?

A

Type I
- Slow twitch
- Postural muscles
- Slow sustained contraction

Type II
- Fast twitch
- Rapid, quick, and powerful muscles
- Responsible for making us stronger and reflexes
* which is why reflexes diminish with age, specifically after age 70

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6
Q

What are characteristics of synovial joints?

A

Diarthrosis joint
Has synovial fluid
Enclosed capsule
Ligaments on the outside and sometimes on the inside.
- prevents movement
Loaded with blood vessels and nerves
- pain and proprioception

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7
Q

Where are proprioceptive fibers found?

A

Distal ends of bones in the joint

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8
Q

What is osteoarthritis?

A

When it affects more than 2 joints, they call it degenerative joint disease
Wearing away of the joint
- Obesity
- Aggressive activities
- Previous injury (traumatic or secondary OA)
- Diseases like Lupus, diabetes, fibromyalgia
- Genetics
Equal in men and women after age 50
Number one reason for joint replacements

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9
Q

Herberden’s nodes

A

DIP

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10
Q

Bouchard’s nodes

A

PIP

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11
Q

Anterior hip precautions

A

No extension
No crossing midline
No external rotation

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12
Q

Posterior hip precautions

A

Don’t bend hip to 90º
Don’t cross midline
No internal rotation

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12
Q

What adaptive equipment is needed after hip replacement?

A

Anterior:
- ADD/ABD wedge
- Any posterior can be used for anterior but not necessary

Posterior:
- ADD/ABD wedge
- Sock aid
- Long handle shoe horn
- Raised toilet seat
- Reacher
- Dressing stick
- RAISED shower chair/stool
- Grab bars
- Handheld shower head
- Walker, cane
- Raised bed and recliner, car

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13
Q

Weight bearing precautions

A

NWB
WBTT
TTWB
PWB
TWB

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14
Q

Sleep precautions for hip replacement

A

Sleep on back for 6 weeks
Can sleep on surgical side

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15
Q

Rheumatoid arthritis

A

Can lead to osteoarthritis
Systemic
Swollen, inflamed synovial membrane
Usually affects MCP and PIP
Often starts in small joints and spreads to larger joints
Morning pain and stiffness for more than 30 minutes

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16
Q

What are the 3 levels of RA according to the American College of Rheumatology?

A

Type 1: self limiting
Type 2: mildly progressive, conservative intervention
Type 3: severe progression

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17
Q

Acute care of arthritis

A

Move it, calm it, support it
- education
- AROM with no pain
- modalities (ice, retrograde massage, compression, ice massage, contrast bath)
* US/diathermy (pulsed/nonthermal)
* e-stim (interferential)
* fluidotherapy/whirlpool (desensitization, help with pain, minimize gravity, ease movement)
- gentle stretching
- functional tasks
- orthotics
- assistive devices

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18
Q

Rules of joint protection

A

Respect pain
Use larger joints
Use joints in their most staple positions
Avoid odd positions
Maintain ROM and strength
Avoid staying in one position for a long time
Don’t start something you can’t stop
Listen to your body
Balance rest and sleep
Use two hands when you can

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19
Q

What are common arthritic deformities?

A

Due to biomechanical changes, tendons can stretch or rupture
Swan neck
Boutonniere
Ulnar drift
Bouchard’s nodes
Herbeden’s nodes

20
Q

Swan neck deformity

A

Lateral bands of the extensor mechanism slip above the PIP, thereby hyperextending the PIP joint and flexing of the DIP
Oval 8 ring splint

21
Q

Boutonniere deformity

A

flexion of the PIP joint and hyperextexion of the DIP occurs when synovitis weakens, lengthens, or disrupts the dorsal capsule and central slip of the extensor mechanism; the lateral bands displace volarly below PIP
Oval 8 ring splint

22
Q

Things to consider with hip fx

A

Bed mobility and rolling over
Get into tub
- Lifted shower bench, bend the knee to get in so you don’t bend at hip
Sitting for ADLs
- Raise chair of seat
Adaptive equipment
- Bedside commode (reimbursed unlike raised toiler seat, can be placed over toilet), reacher so they don’t have to bend to pick stuff up, sock aide, dressing stick for pants and to take off socks, adduction pillow, shoehorn
Usually walking with cane by 6 weeks
Hip restrictions for 6-8 weeks
Abduction wedge
SCD - sequential compression devices
- Ted hose (compression socks)
Incentive spirometer
- For breathing, helps patient clear lungs after surgery

23
Q

How are knee replacements different from hip replacements?

A

Weight bearing to tolerance
No restrictions
Can bend, cross, and roll
No tub until 48 hours after removal of stitches

24
Q

What is the classification criteria for RA?

A
25
Q

Subacute stage of RA

A

Begin to introduce heat in moderation
- contrast bath
- continuous US
- hot pack
- fluidotherapy/whirpool
- paraffin
Goal is to restore ROM through pain free P/AROM or use of dynamic orthotic (LMB).
- functional activities based on occupations and function.
Prevent flare ups.
Adapt and modify equipment

26
Q

Inactive stage of RA

A

Paraffin
Joint protection
Orthotics
- maintain or prevent decline

27
Q

ACR classification: Class I

A

Able to perform usual ADLs

28
Q

ACR classification: Class II

A

Able to perform usual self-care and vocational activities, but limited in avocational activities

29
Q

ACR classification: Class III

A

Able to perform usual self-care activities, but limited in vocational and avocational activities

30
Q

ACR classification: Class IV

A

Limited in ability to perform usual self-care, vocational, and avocational activities

31
Q

Mallet (jersey) finger

A

DIP in flexion
Rupture of distal terminal tendon
Often turns into swan neck
Straight finger orthotic for 6-8 weeks

32
Q

Causes of osteoporosis

A

Animal protein
Caffeine
Smoking
Salt
No exercise
Soft drinks
Alcohol

33
Q

Osteoporosis

A

A bone disease that develops when bone mineral density and bone mass decreases, or when the quality or structure of bone changes.
This can lead to a decrease in bone strength that can increase the risk of broken bones (fractures).

34
Q

Signs of osteoporosis

A

Flattening of cervical lordosis
Exaggeration of thoracic kyphosis
Flattening of lumbar lordosis

35
Q

Common fx in elderly

A

Hip fx
FOOSH

36
Q

Types of fx

A

Greenstick: incomplete fracture. A portion of the bone is broken, causing the other side to bend.
Transverse: break is in a straight line across the bone.
Spiral: break spirals around the bone; common in a twisting injury.
Oblique: break is diagonal across the bone
Compression: bone is crushed. This causes the broken bone to be wider or flatter in appearance.
Comminuted: bone has broken into three or more pieces and fragments are present at the fracture site.
Segmental. The same bone is fractured in two places, so there is a “floating” piece of bone.

37
Q

What are specific issues that can cause LBP?

A

Disc issues
- DJD
- DDD
- herniation
- rupture
Nerve compression
Decreased mobility
Spinal stenosis
Spondylolisthesis
Muscle strain/ligament sprain
Osteoarthritis
Scoliosis/kyphosis

38
Q

Spinal stenosis

A

Narrowing of the spinal canal, most common in lower back
Commonly caused by osteoarthritis

39
Q

Spondylolisthesis

A

Vertebrae shift due to disc degeneration
Can result in paralysis in extreme cases

40
Q

What can OT do about LBP?

A

Education
AROM/strengthening
Pain free activity and exercises
Joint protection

41
Q

What are the rules of joint protection?

A

Control weight
Reduce excessive load on the joint
Avoid pain
Balance rest and activity
Avoid one position
Use larger joints instead of small ones
Avoid positions of deformity
Adaptations and modifications

42
Q

What are the goals of treating LBP?

A

Decrease pain
Prevent or control joint damage
Increase function

43
Q

What are the 8 commandments of lifting?

A
  1. Plan your lift and test load
  2. Ask for help
  3. Get a firm footing
  4. Bend your knees
  5. Tighten your stomach muscles
  6. Lift with your legs
  7. Keep the load close
  8. Keep your back upright
44
Q

What are the levels of assistance? *Can be physical, cognitive, or social

A

7: complete I (timely and safe)
6: MI (device, extra time, modified method)
5: supervision/SBA/contact guard (balance cues, they do 100% of the task)
4: min assist (subject does 75-99%)
3: mod assist (subject does 50-74%)
2: max assist (subject does 25-49%)
1: total assist (subject does 0-24%)

45
Q

Modification

A

Changing the task
- pill sorter
- wheelchair ramp
- adaptive driving
- modified techniques

46
Q

Adaptation

A

grab bars
shower bench (allows for transfers)
shower chair (has a back) shower stool (no back)
walkers, crutches

47
Q

Types of mobility assistance

A

4 pt walker
Rollator/wheeled walker
Platform walker
Hemi walker
Cane (1pt)
Crutches
- standard: can impinge brachial plexus, cause skin integrity issues
- cuff crutch
- peg leg
Scooter
Wheelchair

48
Q

Decreased mobility leads to…

A

decreased balance
skin breakdown
decreased engagement
increased risk of osteoporosis due to decreased wt bearing

Geriatrics (20 decks)

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