Aging musculoskeletal

Question 1

sarcopenia

Answer 1

age related loss of skeletal muscle mass and function

Decreased protein reserves
Challenge to meet protein synthesis demands with injury or disease

Question 2

Normal aging and muscle

Answer 2

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

Question 3

Muscle metabolic changes

Answer 3

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

Question 4

Bone density decreases after age

Answer 4

50

Question 5

Aging and the skeleton

Answer 5

increased osteoclastic activity

Decreased osteoplastic activity

Osteopenia leads to osteoporosis

Question 6

osteopenia

Answer 6

Decreased joint load absorption
Decreased load dispersion to all portions of the joint

Increased focal bone loading and increased risk of fracture

Question 7

joint and normal aging

Answer 7

Decreased activity of osteoblast and chondroblasts

Increased activity of osteoclasts and chondroclasts

decrease response to growth factors

Altered response to tissue loading

Question 8

connective tissue and normal aging

Answer 8

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

Question 9

Cartilage changes with aging

Answer 9

Chondrocyte senescence

Inflammatory environment + senescence= OA

Question 10

IVD and aging

Answer 10

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

Question 11

common changes and joints

Answer 11

Decreased joint space
Increased laxity
Altered load dispersion
Altered joint forces
Decreased joint range of motion

Question 12

cervical spine range of motion trends

Answer 12

Global loss of range of motion

Greatest reduction and extension and lateral flexion

Question 13

thoracic and lumbar spine range of motion, trends

Answer 13

Extension most limited

Little to no change in rotation

Question 14

hip range of motion, trends

Answer 14

Extension decreases
Results in decreased walking speed

Question 15

Ankle range of motion, trends

Answer 15

Dorsiflexion decreases

Question 16

knee range of motion, trends

Answer 16

Without pathology, knee ROM doesn’t change

Question 17

shoulder ROM trends

Answer 17

function and external rotation decreases

Thoracic kyphosis affects ROM

Question 18

common changes in posture

Answer 18

forward head
Increase thoracic kyphosis
Decreased lumbar lordosis

Question 19

sagittal plane alignment affects

Answer 19

joint load dispersion
Muscle length tension relationships
Balance

Question 20

hyperkyphosis

Answer 20

spinal extensors lengthened and weak
Difficulty lifting

Question 21

forward head posture challenges

Answer 21

Challenges with swallowing breathing and supine and prone positioning

Question 22

decreased lumbar lordosis

Answer 22

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

Question 23

modifiable risk factors for osteoporosis

Answer 23

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

Question 24

patient with osteoporosis you avoid putting them in

Answer 24

loaded flexed positions

flexion
low challenge- hook lying position, hold abdominal wall
high challenge- neutral lordosis, abdominal hollow controlled heel slides

Question 25

patients with spinal stenosis you want to avoid

Answer 25

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

Question 26

aggravating and easing factors for spinal stenosis

Answer 26

No pain when seated
Symptoms improved with sitting
Symptoms worse with walking
Severe lower extremity pain

Question 27

Clinical cluster for spinal stenosis

Answer 27

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