Impaired Joint Mobility

Question 1

How can joint structures be categorized?

Answer 1

chondroid, fibrous, and bony

Question 2

Chondroid:

Answer 2

cartilaginous, articular cartilage, labrum, meniscus

Question 3

Fibrous

Answer 3

tendons and ligaments

Question 4

Chondroid Structure Changes

Answer 4

Loading history makes it difficult to distinguish typical from pathological chondroid aging changes
Articular cartilage calcification appears to be typical aging response
Intervertebral disc:

Question 5

Intervertebral disc:

Answer 5

Nucleus more fibrous, annulus less organized

Loss of water content, decreased height -> risk for spinal stenosis

Question 6

Fibrous Structure Changes

Answer 6

Information on normal aging of fibrous structures limited
Fibrous structures thought to demonstrate increased stiffness and decreased elasticity with age
Animal models suggest decreased tensile strength with age

Question 7

Bone Changes

Answer 7

Thickness and density of subchondral bone tends to decrease with age
Increased osteoclast activity and decreased osteoblast activity -> risk of osteopenia/osteoporosis
Bone’s ability to absorb load compromised with osteopenia and osteoporosis

Question 8

Whole Joint Changes

Answer 8

Decreased ROM with age, nonuniformly among joints
ROM deficits may be direction-specific within a joint
ROM deficits usually more pronounced in LE and trunk, less so in UE

Question 9

Stage I OA

Answer 9

doubtful
minimum disruption
10% cartilage loss

Question 10

Stage II OA

Answer 10

mild
joint space narrowing
cartilage begins to break down
occurence of osteophytes

Question 11

Stage III OA

Answer 11

moderate
moderate joint space reduction
gaps in cartilage can explan until they reach bone

Question 12

Stage IV OA

Answer 12

severe
joint space greatly reduced
60% of cartilage is already lost
Large ostephytes

Question 13

Osteoarthritis

Answer 13

Approximately 60% of people age 65+ self-report OA symptoms

Arthritis-attributable activity limitation reported by 22% of people age 65+

Question 14

Interventions for Joint Mobility

Answer 14

Stretching
Strengthening
Manual Therapy
Therapeutic Exercise

Question 15

Stretching for Joint Mobility

Answer 15

Evidence that stretches held > 15 seconds improve ROM

Debate whether improvements in joint mobility lead to improved function, conflicting results found in systematic review:

Question 16

Strengthening for Joint Mobility

Answer 16

Muscle strengthening improves joint mobility via indirect mechanisms
Dynamic loading thought to stimulate growth of joint connective tissue structures
ROM gains found in study participants engaged in strengthening-only program

Question 17

Manual Therapy for Joint Mobility

Answer 17

Age is not a contraindication to joint mobilization/manipulation
AP mobilization forces are below level required to induce fracture in osteoporotic bone

Question 18

Neck Disability Index MCID:

Answer 18

10 points

Question 19

Qiuickdash MCID:

Answer 19

10-15 points

Question 20

Owestry MCID:

Answer 20

10 points

Question 21

LEFS MCID

Answer 21

9 points

Question 22

Patient Specific Functional Scale significant difference:

Answer 22

3 pts or more significant; average of 2 pts or more across categories is significant