Aging musculoskeletal Flashcards
sarcopenia
age related loss of skeletal muscle mass and function
Decreased protein reserves
Challenge to meet protein synthesis demands with injury or disease
Normal aging and muscle
Type two atrophy is greater than type one atrophy
Muscle fiber denervation
muscle is 50% total body weight and young adults and is reduced to 25% by age 75
reduce numbers of motor unit activation
Decreased muscle activation
Decreased excitability of spinal and cortical tissues
Muscle metabolic changes
Decreased resting, metabolic rate
Less lean muscle mass
Insulin resistance
Due to increase body fat
(insulin- regulator of protein metabolism)
decreased growth hormone
Decreased estrogen and testosterone
Vitamin D deficiency
Decreased satellite cells
Bone density decreases after age
50
Aging and the skeleton
increased osteoclastic activity
Decreased osteoplastic activity
Osteopenia leads to osteoporosis
osteopenia
Decreased joint load absorption
Decreased load dispersion to all portions of the joint
Increased focal bone loading and increased risk of fracture
joint and normal aging
Decreased activity of osteoblast and chondroblasts
Increased activity of osteoclasts and chondroclasts
decrease response to growth factors
Altered response to tissue loading
connective tissue and normal aging
altered homeostasis, decreased regenerative response
Decreased size and activity of tendon stem cells
Decrease in elastic fibers, responsible for pliability and tensile strength
Alterations in ground substance
Fragment of collagen, strands, and decreased rate of turnover
Increased cross-linking between collagen molecules
-Increased stiffness and decreased ability to absorb energy
Cartilage changes with aging
Chondrocyte senescence
Inflammatory environment + senescence= OA
IVD and aging
nucleus has less water and proteoglycan content= more fibrous
annulus Has less tensile strength due to collagen deposition and cross-linking
Decrease disc height- can lead to loading of surrounding structures
common changes and joints
Decreased joint space
Increased laxity
Altered load dispersion
Altered joint forces
Decreased joint range of motion
cervical spine range of motion trends
Global loss of range of motion
Greatest reduction and extension and lateral flexion
thoracic and lumbar spine range of motion, trends
Extension most limited
Little to no change in rotation
hip range of motion, trends
Extension decreases
Results in decreased walking speed
Ankle range of motion, trends
Dorsiflexion decreases
knee range of motion, trends
Without pathology, knee ROM doesn’t change
shoulder ROM trends
function and external rotation decreases
Thoracic kyphosis affects ROM
common changes in posture
forward head
Increase thoracic kyphosis
Decreased lumbar lordosis
sagittal plane alignment affects
joint load dispersion
Muscle length tension relationships
Balance
hyperkyphosis
spinal extensors lengthened and weak
Difficulty lifting
forward head posture challenges
Challenges with swallowing breathing and supine and prone positioning
decreased lumbar lordosis
increase facet joint loads
osteophyte formation
neural compromise
decreased ability to withstand compression tension and shear
Increased loadbearing on the neural arch
Thinning trabeculae of bone- fractures risk
Decreased elastin in spinal ligaments - hypertrophy of ligaments may further compromise space
modifiable risk factors for osteoporosis
Low consumption calcium and vitamin D
Low consumption of fruits and vegetables
Excessive caffeine intake
Physical inactivity
Alcohol smoking
Excessive weight loss
Long-term corticosteroid use
patient with osteoporosis you avoid putting them in
loaded flexed positions
flexion
low challenge- hook lying position, hold abdominal wall
high challenge- neutral lordosis, abdominal hollow controlled heel slides
patients with spinal stenosis you want to avoid
Loading in extension
extension
Low challenge - patient facing wall, arms overhead, hands resting on wall, palpate extensors as patient lifts hands away from the wall
aggravating and easing factors for spinal stenosis
No pain when seated
Symptoms improved with sitting
Symptoms worse with walking
Severe lower extremity pain
Clinical cluster for spinal stenosis
bilateral symptoms
Leg pain more than back pain
pain during walking and standing
Pain relief upon sitting
Age greater than 48 years
4/5 positive findings is specificity .98
