Musculoskeletal Changes Across the Lifespan Flashcards
Cartilage types
-
Hylaine/Articular Cartilage
- fetal skeleton, joints, trachea, larynx
-
Fibrocartilage
- Meniscus, pubic symphysis, intevertebral discs.
-
Elastic Cartilage:
- Ear & epiglotis
Types of cartilage growth:
- Appositional: New surface
- Interstitial: Increased internal mass
- Limited growth/repair after childhood
Cartilage properties:
nutrients from?
- Lack of innervation, vascularization
- Nutrients from diffusion
- Compression/Decompression
Cartilage: Over Time
- Thinning
- Atrophy
- Decreased water content
- Decreased number of Chondrocytes
- Rougher surface → decreased efficiency
Bone is formed by endochondral ossification except:
Clavicle, carpals and tarsals, mandible, skull
Diaphysis is ossified at
birth
Bony maturity by
20 y
Epiphyseal plate forms in
early childhood
Interstitial bone growth:
- Growth in lenght (occurs befor growth in diameter)
- Compression forces (ideally symmetrical, perpendicular)
Appositional bone growth:
- Growth in diameter
- Most rapid during prenatal period
Joints form at _____ weeks gestation
6-8
- Change in response to loading and movement
- Acetabulum shows significant changes
Femoral anteversion ________(decreases or increases?) over time
decreases
new born is 25 -30 deg
adult 10 -15 deg
knee aligment development
- new born: peak varum
- 1-2 yr: straight
- 2-4 yr: peak valgum
- 16 yr: straight
Bone in infancy and childhood:
- Growth is dynamic at this point
- Spontaneous resolution
- Relatively rapid response to ortho intervention
-
Epiphysis vulnerable:
- Infection or fracture
- Asymmetrical growth
Growing pains
- 4-12 year olds
- Late evening or night, resolve by am
- Muscle grows slower than bone
Growth spurts at what age?
- 12-13 y for girls
- 14-16 for boys
- Decreased flexibility
- Length grows faster than cortical strength
The role of hormones testosterone and strogen in bone growth
- Estrogen: Slows bone resorption (inhibits osteclasts activity)
- Testosterone: Enhances calcium absorption (increases osteoblast activity)
Bone: Activity Related Concerns
Salter-Harris fractures
Epiphyseal Injury
Greenstick Fracture
in children
Adolescent Bone Concerns:
- Scoliosis
- Apophysitis
- Apophyseal avulsion
- Stress fracture
Cobb angle
- Named for convex side
- curve in scoliosis measurement
- Structural vs. Non structural
- 0-20: Monitor
- 20-40: Bracing & Exercise
- 40: Surgical stabilization
Risser sign
- Bone Maturity measurement
- 0 to 5 scale
- 5 is completely closed
Growth plates begin closing in ______ . And are complete by ____.
- childhood
- Complete by 25 years
- Vertebra close last
- Remodeling continues
Annulus Fibrosis: Increasingly fibrotic
Peak lost:
20-40y
Adult Bone Concerns:
- Back pain/Disc changes
- Nucleus Pulposus: Loss of volume
- Annulus Fibrosis: Increasingly fibrotic
Pre-natal and 1st year: _____(increases or decreases) number of fibers
Increased
After 1st year: Increased fiber _______
size
muscle maturation is achieved when
- Relaxation speed improves
- Adult speeds reached by 10
Bone growth is faster or slower than muscle?
faster
Boys have a longer ___________ and sharper
acceleration in growth
“growing period”
Strength training can decrease speed of loss but not
______
prevent it
Sarcopenia:
- Muscle wasting: decline in number and size of muscle fibers
- Not typical!
- Reported by 6-15% of older adults
∗ Activity level
∗ Hormonal level
∗ Loss of contractile properties
Strength over the Lifespan: adults
- Continued increase into 20s
- Peaks in the 30s
- Declines into the 50s
- Strength training can decrease speed of loss but not prevent
- Frailty and advanced age are not contraindications for strengh training.
cobb angle of 18 deg
just monitor
cobb angle of 25 deg
bracing and exercise
cobb angle of of 45 deg
surgical stabilization
Pt presents with a cobb angle of 22 deg and you decide to:
a. continue to monitor the curve
b. recommend bracing and therapeutic exercises
c. refer to a doctor for surgery
bet 20 -40 deg = bracing and exercise
a 3 y/o has
a. straigh legs
b. peak valgum
c. varum
peak valgum
