Module 9 Flashcards
The primary factor in women developing osteoporosis is
Declining estrogen production
Estrogen effects on osteoclasts and osteoblasts
Reduces life span of osteoclasts and lengthens lifespan of osteoblasts
Primary osteoporosis is associated with
Aging process
Secondary osteoporosis is associated with
Chronic disease, nutritional deficiency and medications
Use of prednisone greater than _ months causes increased
3, bone breakdown and decreased bone replacement
Smoking ____ risk of an osteoporotic fracture compared to non smoker
Doubles
In activity is also a factor causing
Bone loss
The chronic diseases that may cause osteoporosis
RA, diabetes, hyperthyroidism, addisons, or liver disease
Gold standard for osteoporosis
DEXA
T score measures
BMD by comparing it with young healthy women
Z score measures
BMD by comparing it with age and gender match controls
Both t score and z score are _______ measured ___ and ____ the average BMD value
Standard deviations, above and below
BMD of 2.5 ore more below the mean is indicative of
Osteoporosis
BMD of between 1 Nd 2.5 is indicative of
Osteopenia
_____ osteoporosis related fractures occur each year
1.5 million
The amount of fractures related to osteoporosis is almost ____ the amount of heart attacks and strokes
Double
__ in __ women and _ in __ men will have an osteoporosis related fracture in their lifetime
1 in 2 and 1 in 8
FRAX calculates
10 year risk factor for osteoporosis related fracture via questionnaire
The greatest amount of bone density is loss in women occurs within
The first 5 years of menopause
Only _ out of _ women with vertebral compression fracture have symptoms
1 out of 4
Multiple wedge fractures causes spine to curve known as
Gibbus or dowagers hump
Vertebral compressions fractures cause
Loss of height, distended abdomen and stooped posture, increased kyphosis that worsens over time, breathing difficulties, abdominal pain, digestive discomfort, decreased QOL, mobility and energy, pain and deterioration of physical function, increased long term morbidity and mortality
Bisphosphonates decrease
Osteoclasts activity
Three types of bisphosphonates
Alendronate (Fosamax), risedronate (actonel) and calcitonin (miacalcin)
Selective estrogen receptor modulators is an ____ _____, example is
Estrogen agonist, Raloxifene (Evista)
These two procedures are used to treat patients with intractable pain who have vertebral fractures
Vertebroplasty and kyphoplasty
In vertebroplasty and kyphoplasty, ____ is injected into the ____ which ____
Methylmethacrylate, vertebral body, restores some vertebral height and stabilizes fracture
Kyphoplasty involves inserting a
Balloon tamp into the vertebral body prior to injecting the cement
Studies have shown a significant relief of pain in __% to _% in patients with compression fracture that get kyphoplasty , even 5 years later they still have pain relief
90-95
Combined resistance training protocols in one study is defined as
The combination of resistance training and high impact or weight bearing exercise
Combined resistance training protocols were effective in improving BMD in the
Femoral neck and lumbar spine
A high load exercise is
80% of 1RM
Exercise protocol to increase BMD
Weight bearing / heavy loading with few repetitions and high strain
Within ______ of stopping exercise there can be a measurable decrease in BMD
One month
Low load, high rep may lead to
Low bone mass
Osteopenia is a t score between
-1 and - 2.5
Osteomalacia is
Bone disorder caused by a failure of calcification of bone matrix
Osteomalacia is diagnosed by
Bone biopsy and blood test
Osteomalacia causes ___ of bones
Softening
Osteomalacia is a dysfunction in
Metabolizing vitamin. d
Most common cause of osteomalacia In older adults is
Vitamin d deficiency as a result of inadequate intake, lack of exposure to sun, GI malabsorption, extensive burns, chronic diarrhea, drugs such as Dilantin
Artery most effected in femoral AVN
Circumflex
Signs and symptoms of AVN
Natal gif gait pattern, groin pain radiating to pelvis knee and back,later muscle atrophy and joint mobility restriction
Paget’s disease or ___
Osteitis deformans
Paget’s disease most often effects
The pelvis, long bones, spine, ribs, sternum and cranium
Symptoms of Paget’s disease
Bone pain, joint pain or stiffness, bowing of the femur and tibia, thoracic kyphosis, enlarged head and skull deformity, fracture, gait deviations
Drug therapy options for Paget’s
Calcitonin-salmon (mialcin), NSAIDs, bisphosphonates
Arthritis is
Degeneration of articular cartilage and inflammation of synovium
OA most often occurs in
CMC joint, knee and hip
OA exercise program
Low load, prolonged stretching performed several times per day
Over __% of THA And TKA are performed in older adults with OA
70
RA is
A systemic inflammatory autoimmune disease and disabling condition
RA effects women __ times more than men
3 times
Joints most effected in RA
Distal, bilateral joints
Blood test findings in RA
DecreasedRBCs, increased erythrocytes sedimentation rate and (+) rheumatoid factor
Drug therapy for RA
Disease modifying anti rheumatic drugs (DMARDs), in combo with NSAIDs, or corticosteroids in low doses
Cervical RA is typically in these areas of the c spine
Posterior and mid cervical
Spindylosis of c spine results from
Disc degeneration, facet arthropathy, osteophyte formation, ligamentous thickening and loss of cervical lordosis, loss of disc height
Radiculitis into the UE from spondylosis happens in ___ of patients
25%
Vertebral artery syndrome is characterized by
Vertigo attacks, dizziness, tinnitus, blurred vision, nausea, nystagmus, and ataxia induced by head rotation
VAS is due to
Compression of the vertebral artery terminating in the posterior inferior cerebellar artery
Ossification of the PLL will limit
Flexion
____ is responsible for 90% of all adult spinal surgeries
DDD
Decrease in disc height of ____ can overload facet joints
3 mm
Initial spine instability with aging is caused by the
Dehydration Of the IV disc
Spine attempts to counter dehydration with
Bone modeling
Facet Artois and degeneration does not occur without the presence of
Adjacent disc degeneration
The most common cause of neurological leg pain in older adult is
Spinal stenosis
End feel in shoulder OA
Hard with limited mobility
PT joint mob treatment of shoulder OA or adhesive capsulitus
Grade 1-2 oscillations or sustained
Most common shoulder pathology is
Rotator cuff issue
Most common site of impingement
Subacromial space
Most common cause of shoulder pain in active older adult iOS
Impingement and rotator cuff
Symptoms of shoulder pathology
Can’t lay on painful side, crepitus or catching sensation and positive Impingement sign
Shoulder pathology will present with weakness in
Shoulder ABD and flexion
Problem that may occur after rotator cuff issue in elderly
Adhesive capsulitus
Tendinopathy vs bursitis: passive rotation test in full flexion and ADD is less in
Tendinopathy
Tendinopathy vs bursitis : greater pain in resisted test in full flexion, ADD and ER
Tendinopathy
Tendinopathy may benefit with
Transverse friction applied at insertion
Bursitis will worsen with
Massage
Persistent bursitis may indicate
Calcific tendinitis or tear, reflecting an inflammatory reaction in adjacent basal tissue k
How do you differentiate subacromial contractile vs non contractile issues
If a resisted static contraction of a muscle causes pain in neutral, repeat test with slight subacromial distraction, assess difference in pain response. If pain lessens or contraction power increases it is other structures in subacromial space. If pain unchanged most likely rotator cuff tendon
Which occurs more commonly bursitis or OA of the shoulder
Bursitis
Symptoms of bursitis include
Palpable tenderness, pain with movement of muscle effected by bursa and symptom relief with rest
Bursitis patients typically have a history of
Overuse
In asymptomatic older adults aged 50-59 ultrasound found rotator cuff tears in
13%
In asymptomatic older adults aged 60-69 ultrasound found rotator cuff tears in
20%
In asymptomatic older adults aged 70-79 ultrasound found rotator cuff tears in
31%
In asymptomatic older adults aged 80+ ultrasound found rotator cuff tears in
51%
Less than ____ is diagnostic RTC tear on x Ray
5mm
Strength deficit in RTC
Shoulder elevation and ER
Adhesive capsulitis is more common in females or males
Females
Adhesive capsulitis is a possible complication of
DM and thyroid disease
Adhesive capsulitis occurs because of the presence of
Cytokine levels a minor insult could initiate an inflammatory healing respond resulting in exaggerated and sustained inflammation and fibrosis response
What is Milwaukee shoulder syndrome
A rare and destructive form of arthropathy characterized by pain, joint or bursa effusion and deposition of calcium hydroxyapatite crystals
Weeks 1-3 after humeral fracture
Sling, no PROM, codmans pendulum , scapular retraction and AROM distal joints
Weeks 4-8 after humeral fracture
Gentle isometrics, AROM flexion in supine, progress with weights , elevation in standing with stick or pulleys with eccentric lowering of involved arm
Week 8 humeral fracture
Resistive exercises : standing forward press, therabamd resisted flexion, IR, ER, ABD and rowing . Self stretching
Total shoulder arthropathy is indicated for
Post traumatic or severe arthritis, AVN, severe fracture, complete RCT, previous TSA failure
TSA shoulder immobilizer is worn for how long
Daytime for one week and nighttime for a month
PROM for shoulder after TSA is initiated
Day one post op and continued for 5 weeks
If sunscapularis was released in TSA then no
ER
3 weeks post op TSA consists of
Assisted elevation
5 weeks post op TSA consists of
AAROM and stretching , isometrics
Radial head fractures in elbow are __ of all traumas and ___ of elbow fractures
1/4 and 1/3
Full elbow rom after fracture will return ________
12-15 weeks
Colle’s fracture is
A distal radius fracture with dorsal and radial displacement of wrist and hand referred to as dinner fork deformity
Colle’s fracture in common in
Osteoporosis
Average age of onset of dupuytrens contracture is
60
Dupuytrens is when
Longitudinal bands of the palmar aponeurosis undergo fibrosis, MCP and PIP joints are flexed
Swan neck deformity is when
DIP flex and PiP extend
Swan neck does not occur in the
Thumb
Boutonnière deformity is also called
Button hole deformity
Boutonnière deformity is when
Middle phalanx central slip is unstable or torn and the flexor tendon flexes the PIP joint without resistance and the laters, bands begin to slide down along side the finger where they continue to extend the DIP
Most common hip joint disease
OA
___ pain is most common hip joint complaint
Groin pain
Posterolateral hip pain along the greater trochanter suggests
Trochanteric bursitis, gluteal insertion Tendinopathy or component loose in THA
The chronological sequence of degeneration seen on x Ray and CT
Joint space narrowing, development of osteophytes, subchondral demineralization, sclerosis and cyst formation, loose bodies,, joint malalignment and deformity.
Osteonecrosis is
Process of creeping substitution where there is resorption of dead trabeculae and woven bone laid Down on dead trabeculae resulting in collapse of bone
AVN is associated with
Long term use of corticosteroids, excessive alcohol intake, diabetes, obesity, gout and cushings disease
Platelet rich plasma
Enhances neovascularization, accelerated healing and promotes better scar tissue quality
95% of hip fractures are
Intertrochanteric or femoral neck fractures
Remaining 5% of hip fractures are
Subtrochanteric fractures usually results of high velocity fall
Cemented THA allows ___ post op
FWB
Cement less THA more appropriate for
Younger and active people with better bone quality
Hybrid THA is
Cemented femoral component and a cementless ace tabular component
Leading cause of disability in the U.S. is
Knee OA
___ weakness has been implicated in the development and progression of knee joint degeneration
Quadriceps
The strongest single predictor of functional limitations in patients with knee OA is
Quad strength
Ability to volitionally control quadriceps muscle force activation after TKA ranges from
17-67%
High intensity NMES has been shown effective in augmenting quadriceps strength true or false
True
Knee prosthesis failure rate increases _% each year from about _% at _ years to _% at _ years
1%, 10% , 10 years, 20%, 20 years
