Module 9 Flashcards
1
Q
The primary factor in women developing osteoporosis is
A
Declining estrogen production
2
Q
Estrogen effects on osteoclasts and osteoblasts
A
Reduces life span of osteoclasts and lengthens lifespan of osteoblasts
3
Q
Primary osteoporosis is associated with
A
Aging process
4
Q
Secondary osteoporosis is associated with
A
Chronic disease, nutritional deficiency and medications
5
Q
Use of prednisone greater than _ months causes increased
A
3, bone breakdown and decreased bone replacement
6
Q
Smoking ____ risk of an osteoporotic fracture compared to non smoker
A
Doubles
7
Q
In activity is also a factor causing
A
Bone loss
8
Q
The chronic diseases that may cause osteoporosis
A
RA, diabetes, hyperthyroidism, addisons, or liver disease
9
Q
Gold standard for osteoporosis
A
DEXA
10
Q
T score measures
A
BMD by comparing it with young healthy women
11
Q
Z score measures
A
BMD by comparing it with age and gender match controls
12
Q
Both t score and z score are _______ measured ___ and ____ the average BMD value
A
Standard deviations, above and below
13
Q
BMD of 2.5 ore more below the mean is indicative of
A
Osteoporosis
14
Q
BMD of between 1 Nd 2.5 is indicative of
A
Osteopenia
15
Q
_____ osteoporosis related fractures occur each year
A
1.5 million
16
Q
The amount of fractures related to osteoporosis is almost ____ the amount of heart attacks and strokes
A
Double
17
Q
__ in __ women and _ in __ men will have an osteoporosis related fracture in their lifetime
A
1 in 2 and 1 in 8
18
Q
FRAX calculates
A
10 year risk factor for osteoporosis related fracture via questionnaire
19
Q
The greatest amount of bone density is loss in women occurs within
A
The first 5 years of menopause
20
Q
Only _ out of _ women with vertebral compression fracture have symptoms
A
1 out of 4
21
Q
Multiple wedge fractures causes spine to curve known as
A
Gibbus or dowagers hump
22
Q
Vertebral compressions fractures cause
A
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
23
Q
Bisphosphonates decrease
A
Osteoclasts activity
24
Q
Three types of bisphosphonates
A
Alendronate (Fosamax), risedronate (actonel) and calcitonin (miacalcin)
25
Selective estrogen receptor modulators is an ____ _____, example is
Estrogen agonist, Raloxifene (Evista)
26
These two procedures are used to treat patients with intractable pain who have vertebral fractures
Vertebroplasty and kyphoplasty
27
In vertebroplasty and kyphoplasty, ____ is injected into the ____ which ____
Methylmethacrylate, vertebral body, restores some vertebral height and stabilizes fracture
28
Kyphoplasty involves inserting a
Balloon tamp into the vertebral body prior to injecting the cement
29
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
30
Combined resistance training protocols in one study is defined as
The combination of resistance training and high impact or weight bearing exercise
31
Combined resistance training protocols were effective in improving BMD in the
Femoral neck and lumbar spine
32
A high load exercise is
80% of 1RM
33
Exercise protocol to increase BMD
Weight bearing / heavy loading with few repetitions and high strain
34
Within ______ of stopping exercise there can be a measurable decrease in BMD
One month
35
Low load, high rep may lead to
Low bone mass
36
Osteopenia is a t score between
-1 and - 2.5
37
Osteomalacia is
Bone disorder caused by a failure of calcification of bone matrix
38
Osteomalacia is diagnosed by
Bone biopsy and blood test
39
Osteomalacia causes ___ of bones
Softening
40
Osteomalacia is a dysfunction in
Metabolizing vitamin. d
41
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
42
Artery most effected in femoral AVN
Circumflex
43
Signs and symptoms of AVN
Natal gif gait pattern, groin pain radiating to pelvis knee and back,later muscle atrophy and joint mobility restriction
44
Paget's disease or ___
Osteitis deformans
45
Paget's disease most often effects
The pelvis, long bones, spine, ribs, sternum and cranium
46
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
47
Drug therapy options for Paget's
Calcitonin-salmon (mialcin), NSAIDs, bisphosphonates
48
Arthritis is
Degeneration of articular cartilage and inflammation of synovium
49
OA most often occurs in
CMC joint, knee and hip
50
OA exercise program
Low load, prolonged stretching performed several times per day
51
Over __% of THA And TKA are performed in older adults with OA
70
52
RA is
A systemic inflammatory autoimmune disease and disabling condition
53
RA effects women __ times more than men
3 times
54
Joints most effected in RA
Distal, bilateral joints
55
Blood test findings in RA
DecreasedRBCs, increased erythrocytes sedimentation rate and (+) rheumatoid factor
56
Drug therapy for RA
Disease modifying anti rheumatic drugs (DMARDs), in combo with NSAIDs, or corticosteroids in low doses
57
Cervical RA is typically in these areas of the c spine
Posterior and mid cervical
58
Spindylosis of c spine results from
Disc degeneration, facet arthropathy, osteophyte formation, ligamentous thickening and loss of cervical lordosis, loss of disc height
59
Radiculitis into the UE from spondylosis happens in ___ of patients
25%
60
Vertebral artery syndrome is characterized by
Vertigo attacks, dizziness, tinnitus, blurred vision, nausea, nystagmus, and ataxia induced by head rotation
61
VAS is due to
Compression of the vertebral artery terminating in the posterior inferior cerebellar artery
62
Ossification of the PLL will limit
Flexion
63
____ is responsible for 90% of all adult spinal surgeries
DDD
64
Decrease in disc height of ____ can overload facet joints
3 mm
65
Initial spine instability with aging is caused by the
Dehydration Of the IV disc
66
Spine attempts to counter dehydration with
Bone modeling
67
Facet Artois and degeneration does not occur without the presence of
Adjacent disc degeneration
68
The most common cause of neurological leg pain in older adult is
Spinal stenosis
69
End feel in shoulder OA
Hard with limited mobility
70
PT joint mob treatment of shoulder OA or adhesive capsulitus
Grade 1-2 oscillations or sustained
71
Most common shoulder pathology is
Rotator cuff issue
72
Most common site of impingement
Subacromial space
73
Most common cause of shoulder pain in active older adult iOS
Impingement and rotator cuff
74
Symptoms of shoulder pathology
Can't lay on painful side, crepitus or catching sensation and positive Impingement sign
75
Shoulder pathology will present with weakness in
Shoulder ABD and flexion
76
Problem that may occur after rotator cuff issue in elderly
Adhesive capsulitus
77
Tendinopathy vs bursitis: passive rotation test in full flexion and ADD is less in
Tendinopathy
78
Tendinopathy vs bursitis : greater pain in resisted test in full flexion, ADD and ER
Tendinopathy
79
Tendinopathy may benefit with
Transverse friction applied at insertion
80
Bursitis will worsen with
Massage
81
Persistent bursitis may indicate
Calcific tendinitis or tear, reflecting an inflammatory reaction in adjacent basal tissue k
82
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
83
Which occurs more commonly bursitis or OA of the shoulder
Bursitis
84
Symptoms of bursitis include
Palpable tenderness, pain with movement of muscle effected by bursa and symptom relief with rest
85
Bursitis patients typically have a history of
Overuse
86
In asymptomatic older adults aged 50-59 ultrasound found rotator cuff tears in
13%
87
In asymptomatic older adults aged 60-69 ultrasound found rotator cuff tears in
20%
88
In asymptomatic older adults aged 70-79 ultrasound found rotator cuff tears in
31%
89
In asymptomatic older adults aged 80+ ultrasound found rotator cuff tears in
51%
90
Less than ____ is diagnostic RTC tear on x Ray
5mm
91
Strength deficit in RTC
Shoulder elevation and ER
92
Adhesive capsulitis is more common in females or males
Females
93
Adhesive capsulitis is a possible complication of
DM and thyroid disease
94
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
95
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
96
Weeks 1-3 after humeral fracture
Sling, no PROM, codmans pendulum , scapular retraction and AROM distal joints
97
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
98
Week 8 humeral fracture
Resistive exercises : standing forward press, therabamd resisted flexion, IR, ER, ABD and rowing . Self stretching
99
Total shoulder arthropathy is indicated for
Post traumatic or severe arthritis, AVN, severe fracture, complete RCT, previous TSA failure
100
TSA shoulder immobilizer is worn for how long
Daytime for one week and nighttime for a month
101
PROM for shoulder after TSA is initiated
Day one post op and continued for 5 weeks
102
If sunscapularis was released in TSA then no
ER
103
3 weeks post op TSA consists of
Assisted elevation
104
5 weeks post op TSA consists of
AAROM and stretching , isometrics
105
Radial head fractures in elbow are __ of all traumas and ___ of elbow fractures
1/4 and 1/3
106
Full elbow rom after fracture will return ________
12-15 weeks
107
Colle's fracture is
A distal radius fracture with dorsal and radial displacement of wrist and hand referred to as dinner fork deformity
108
Colle's fracture in common in
Osteoporosis
109
Average age of onset of dupuytrens contracture is
60
110
Dupuytrens is when
Longitudinal bands of the palmar aponeurosis undergo fibrosis, MCP and PIP joints are flexed
111
Swan neck deformity is when
DIP flex and PiP extend
112
Swan neck does not occur in the
Thumb
113
Boutonnière deformity is also called
Button hole deformity
114
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
115
Most common hip joint disease
OA
116
___ pain is most common hip joint complaint
Groin pain
117
Posterolateral hip pain along the greater trochanter suggests
Trochanteric bursitis, gluteal insertion Tendinopathy or component loose in THA
118
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.
119
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
120
AVN is associated with
Long term use of corticosteroids, excessive alcohol intake, diabetes, obesity, gout and cushings disease
121
Platelet rich plasma
Enhances neovascularization, accelerated healing and promotes better scar tissue quality
122
95% of hip fractures are
Intertrochanteric or femoral neck fractures
123
Remaining 5% of hip fractures are
Subtrochanteric fractures usually results of high velocity fall
124
Cemented THA allows ___ post op
FWB
125
Cement less THA more appropriate for
Younger and active people with better bone quality
126
Hybrid THA is
Cemented femoral component and a cementless ace tabular component
127
Leading cause of disability in the U.S. is
Knee OA
128
___ weakness has been implicated in the development and progression of knee joint degeneration
Quadriceps
129
The strongest single predictor of functional limitations in patients with knee OA is
Quad strength
130
Ability to volitionally control quadriceps muscle force activation after TKA ranges from
17-67%
131
High intensity NMES has been shown effective in augmenting quadriceps strength true or false
True
132
Knee prosthesis failure rate increases _% each year from about _% at _ years to _% at _ years
1%, 10% , 10 years, 20%, 20 years
