MSK Changes in Aging Adults

Question 1

What is Sarcopenia?

Answer 1

Age related loss of skeletal muscle mass and strength which results in decreased protein reserves which avalanches into even worse sarcopenia

However it is not completely age related, can also be due to decreased physical activity and co-morbidities

Question 2

What percentage of total body weight in young adults is muscle mass and how does that change as a person ages?

Answer 2

50% in young adults which changes to 25% by age 75-80

Question 3

Which muscle type atrophy is greater, type I or type II?

What is the muscle replaced with?

Answer 3

type 2 more than type 1

replaced with increasing body fat

Question 4

What happens to muscle activation as we age?

Answer 4

it decreases, and there is less agonist activation with more coactivation of antagonist

leads to decreased muscle strength and power

Question 5

What happens to normal resting metabolic rate as we age and how does that correspond with muscle mass?

Answer 5

decreased resting metabolic rate due to less lean muscle mass

Question 6

What happens to insulin resistant as we age?

Answer 6

it increases

increased body fat further contributes to this issue

Question 7

What happens to Osteclast and chondroclast activty as we age?

Answer 7

Both increase which leads to a net decrease in connective tissue

Question 8

What is osteopenia and what does it lead to an increased risk of?

Answer 8

The naturally aging process where bone loss is greater than bone gain which leads to a decrease in load absorption and increased bone loading (leads to increased risk of fracture)

leads to an increased risk of osteoporosis

Question 9

True or False: The ability to retain water in connective tissue does not normally decrease as we age.

Answer 9

False, it is normal for the ability to retain water to decrease due to decreased glycoconjugates that maintain fluid content

Question 10

What are the most common changes in the normal aging process to a joint?

Answer 10

• decreased joint space
• increased laxity
• altered load dispersion
• altered joint forces
• decreased joint ROM (not uniformly)

Question 11

In the cervical spine of an aging adult, what ROM is common decreased?

Answer 11

all motion is decreased but especially extension and lateral flexion

Question 12

In the thoracic and lumbar spine of an aging adult, what ROM is common decreased?

Answer 12

extension becomes limited, very rarely does rotation change

Question 13

In the hip of an aging adult, what ROM is common decreased?

Answer 13

extension decreases and decreased walking speed

Question 14

In the ankle of an aging adult, what ROM is common decreased?

Answer 14

dorsiflexion decreases

Question 15

In the knee of an aging adult, what ROM is common decreased?

Answer 15

without pathology the knee ROM remains fairly stable

Question 16

In the shoulder of an aging adult, what ROM is common decreased?

Answer 16

flexion and external rotation are limited

thoracic kyphosis may also effect this

Question 17

True or False: Increase thoracic kyphosis is correlated with increased fall risk

Answer 17

true

Question 18

True or False: As we age increase lordosis of the lumbar spine is normal

Answer 18

False, decreased lumbar lordosis (lumbar flattening) is common

Question 19

What challenges are presented with a patient that has forward head posturing?

Answer 19

challenges with swallowing, breathing, supine/prone positioning

Question 20

What altered functions are correlated with decreased lumbar lordosis?

Answer 20

pain, nerve root impingement symptoms, spinal stenosis, walking is painful and overall limitation of activities

Question 21

What are two structural causes of postural changes in aging adults?

Answer 21

decreased intervertebral and bone height (2’ loss over lifetime)

decreased elastin in ligaments of the spine (converts into cartilaginous tissue from scarring, thus become thickened-spinal stenosis)

Question 22

What are four MSK conditions that common impact aging adults?

Answer 22

Osteoporosis (increased fracture risk)
Osteoarthritis (joint arthroplasty)
Spinal stenosis
frailty

Question 23

What is osteoporosis?

What do patients with this condition need to be caution of as far as activity?

Answer 23

a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture

caution with ADLs in trunk flexed positions

Question 24

What joints are commonly effected by Osteoarthritis?

Answer 24

load bearing joint such as the hands, hips, knees, feet, and cervical/lumbar spines

Question 25

What key information does the occupation and activity history question give to a PT?

Answer 25

provides info. on joint loading and whether patient is sedentary or active or at least was when they were employed

Question 26

True or False: PTs need to take vitals for every aging adult patient.

Answer 26

True

Question 27

What two quick tests can a PT do to test postural alignment?

Answer 27

plumb line

wall occiput distance test (if greater than 0 then there is an increased chance of vertebral fractures)

Question 28

What range of motion of the spine is commonly limited in patients with spinal stenosis?

Answer 28

extension

Question 29

For patient with osteoporosis that have difficulty with flexion and flexed position what are Low challenge and high challenge tests?

Answer 29

Low challenge- hook lying position, holding abdomen hollow

high challenge- neutral lordosis, abdominal hollowing, hip/knee flex/ext movements

Question 30

For patient with spinal stenosis that have difficulty with extension and extended position what are Low challenge and high challenge tests?

Answer 30

Low Challenge: patient facing wall with their hands over their head resting on the wall, PT palpates extensors as the patient lifts their hands away from the wall

high challenge- standard position

Question 31

What region of the body does the Western Ontario ask a patient about?

Answer 31

Shoulder (comprised of the OA of the shoulder Index and the rotator cuff index)

Question 32

What are 6 common performance based measurements to use in an MSK exam for aging adults?

Answer 32

functional reach test
timed up and go
five times sit to stand test
six minute walk test
stair climb test
gait speed