MSK Changes in Aging Adults Flashcards
What is Sarcopenia?
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
What percentage of total body weight in young adults is muscle mass and how does that change as a person ages?
50% in young adults which changes to 25% by age 75-80
Which muscle type atrophy is greater, type I or type II?
What is the muscle replaced with?
type 2 more than type 1
replaced with increasing body fat
What happens to muscle activation as we age?
it decreases, and there is less agonist activation with more coactivation of antagonist
leads to decreased muscle strength and power
What happens to normal resting metabolic rate as we age and how does that correspond with muscle mass?
decreased resting metabolic rate due to less lean muscle mass
What happens to insulin resistant as we age?
it increases
increased body fat further contributes to this issue
What happens to Osteclast and chondroclast activty as we age?
Both increase which leads to a net decrease in connective tissue
What is osteopenia and what does it lead to an increased risk of?
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
True or False: The ability to retain water in connective tissue does not normally decrease as we age.
False, it is normal for the ability to retain water to decrease due to decreased glycoconjugates that maintain fluid content
What are the most common changes in the normal aging process to a joint?
- decreased joint space
- increased laxity
- altered load dispersion
- altered joint forces
- decreased joint ROM (not uniformly)
In the cervical spine of an aging adult, what ROM is common decreased?
all motion is decreased but especially extension and lateral flexion
In the thoracic and lumbar spine of an aging adult, what ROM is common decreased?
extension becomes limited, very rarely does rotation change
In the hip of an aging adult, what ROM is common decreased?
extension decreases and decreased walking speed
In the ankle of an aging adult, what ROM is common decreased?
dorsiflexion decreases
In the knee of an aging adult, what ROM is common decreased?
without pathology the knee ROM remains fairly stable
In the shoulder of an aging adult, what ROM is common decreased?
flexion and external rotation are limited
thoracic kyphosis may also effect this
True or False: Increase thoracic kyphosis is correlated with increased fall risk
true
True or False: As we age increase lordosis of the lumbar spine is normal
False, decreased lumbar lordosis (lumbar flattening) is common
What challenges are presented with a patient that has forward head posturing?
challenges with swallowing, breathing, supine/prone positioning
What altered functions are correlated with decreased lumbar lordosis?
pain, nerve root impingement symptoms, spinal stenosis, walking is painful and overall limitation of activities
What are two structural causes of postural changes in aging adults?
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)
What are four MSK conditions that common impact aging adults?
Osteoporosis (increased fracture risk)
Osteoarthritis (joint arthroplasty)
Spinal stenosis
frailty
What is osteoporosis?
What do patients with this condition need to be caution of as far as activity?
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
What joints are commonly effected by Osteoarthritis?
load bearing joint such as the hands, hips, knees, feet, and cervical/lumbar spines
What key information does the occupation and activity history question give to a PT?
provides info. on joint loading and whether patient is sedentary or active or at least was when they were employed
True or False: PTs need to take vitals for every aging adult patient.
True
What two quick tests can a PT do to test postural alignment?
plumb line
wall occiput distance test (if greater than 0 then there is an increased chance of vertebral fractures)
What range of motion of the spine is commonly limited in patients with spinal stenosis?
extension
For patient with osteoporosis that have difficulty with flexion and flexed position what are Low challenge and high challenge tests?
Low challenge- hook lying position, holding abdomen hollow
high challenge- neutral lordosis, abdominal hollowing, hip/knee flex/ext movements
For patient with spinal stenosis that have difficulty with extension and extended position what are Low challenge and high challenge tests?
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
What region of the body does the Western Ontario ask a patient about?
Shoulder (comprised of the OA of the shoulder Index and the rotator cuff index)
What are 6 common performance based measurements to use in an MSK exam for aging adults?
functional reach test timed up and go five times sit to stand test six minute walk test stair climb test gait speed
