PT 305: Topic 9- Musculoskeletal • Clinical Manifestations:

Disorders in Older Adults Progression Usually develops slowly over

Prepared by: Danielle Valerie A. Tabel, PTRP many years in response to
mechanical stress
Musculoskeletal Disorders in Older Adults
Manifestations Cartilage degradation, altered
A. Osteoarthritis joint architecture, osteophyte
B. Rheumatoid Arthritis formation
C. Gout
D. Fracture Joint Affects a few joints (usully
E. Carpal tunnel syndrome Involvement asymetrically); typically:
F. Osteoporosis, - DIP, PIP, 1st CMC of hands
- Cervical and Lumbar spine
G. Low back pain
- Hips, Knees, 1st MTP of feet
H. Sarcopenia
Joint signs and Morning stiffness (usually <30
Osteoarthritis symptoms min), increased joint pain with
• Definition: weightbearing and strenuous
- Aka "Wear and Tear Arthritis" or activity; crepitus and loss of
"Degenerative Joint Disease" ROM
- A chronic degenerative disorder primarily Systemic signs None
affecting the articular cartilage of and symptoms
synovial joints with eventual bone
remodeling and overgrowth at the • Complication:
margins of the joint - Chondrolysis
• Epidemiology:
- Osteonecrosis
- Most common joint disorder in the - Stress fractures
Philippines - Loss of stability
- Affects most people over age 60 - Pinched nerve
- <50 y.o.: Men > Women • Medical/Surgical Management:

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- >50 y.o: Women> Men - Arthroscopic surgery
• Etiology:
- Joint replacement
- Systemic Factors: - Osteotomy
- Age - Joint fusion or Arthrodesis
- Gender • Pharmacological Management:
- Race - Acetaminophen
- Local Factors: - NSAIDs
- Obesity - Antidepressants
- Major joint trauma
- Altered joint biomechanics Rheumatoid Arthritis
• Pathophysiology: • Definition:
- An autoimmune disease that causes
chronic inflammation of the joints (hands,
Aging (↓ water and proteoglycan) wrist and knees)
↓ - The immune system mistakenly attacks
Cartilage deteriorates own body tissues and affects body
↓ organs such as the skin, eyes and lungs
Bone-to-bone contact
↓ • Epidemiology:
Joint pain and inflammation - Typically 2 to 3 times higher in women
↓ than men
Cartilage breaks off causing subchondral bone to - Increases with age
thicken and broaden • Etiology:
↓ - Idiopathic
Inflammation
↓
- Theories of Rheumatoid Arthritis:
New bone growth (osteophyte) - (+) Rheumatoid Factor (RF) or
↓ Seropositivity
Joints stiffen, are painful, and difficult to move - Genetic Predisposition (HLA-DR4)
- Infection- Streptococcus
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 • Pathophysiology: • Etiology:
- Hyperuricemia
- Family history
External trigger sets off an auto-immune reaction - Diet rich in purine:
↓ - Red meat and seafood
Synovial cell hyperplasia and endothelial cell - Sweetened drinks
activation - Alcohol
↓ - Innards
Uncontrolled inflammation
↓ • Pathophysiology:
Consequent cartilage and bone destruction

Increased uric acid

• Clinical Manifestations:
Progression May develop suddenly, within
weeks or months
Manifestations Inflammatory synovitis and
irreversible structural damage to
cartilage and bone
Joint Usually affects many joints,
Involvement usually bilateral; typically:
- MCP and PIP of hands, wrists,
elbows, shoulders
- Cervical spine
- MTP, talonavicular and ankle
inflammatory reaction causing joint pain, erythema
Joint signs and Redness, warmth, swelling and
symptoms prolonged morning stifness;
increased joint pain with activity
• Clinical Manifestations:
Systemic signs General feeling of sickness and
and symptoms fatigue, weight loss and fever;
may develop rheumatoid
nodules, may have ocular,
respiratory, hematological, and
cardiac symptoms
↓
Hyperuricemia
↓
Formation of monosodium urate crystals (MSU)
↓
Deposition of MSU crystals in synovial fluids
↓
White blood cells (phagocytes and leukocytes)
attack the MSU crystals
↓
MSU crystals "pop" the white blood cells
↓
WBC release proteins
↓
Proteins "call in" more WBC and causes an
and swelling
- Severe pain in one or more joints (most
commonly in the big toe)
- Lingering discomfort
- Inflammation and redness
- Limited range of motion

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• Complications:
• Complications: - Tophi
- Premature Heart Diseases - Joint damage and deformity
- Rheumatoid Cachexia - Kidney stones
- Rheumatoid Nodules - Kidney disease and kidney failure
- Peripheral Neuropathy - Psychological and emotional problems
• Medical/Surgical Management: • Medical/Surgical Management:
- Joint Replacement - Tophi removal
- Arthrodesis - Joint fusion
- Synovectomy - Joint replacement
• Pharmacological Management: • Pharmacological Management:
- NSAIDs - NSAIDs
- DMARDs - Colchicine
- Biologics - Corticosteroids
- Steroids
Fracture
Gout • Definition:
• Definition: - A partial or complete break in the
- A common and complex form of arthritis continuity of the bone as a result of
characterized by sudden, severe attacks trauma, acquired disease (osteoporosis),
of pain, swelling, redness and tenderness or of congenital abnormality
in one or more joints, most often in the • Epidemiology:
big toe - Affects more women than men
• Epidemiology: - Most commonly broken bones:
- More prevalent in men than women - Collarbones
- Increases with age - Arms
- Highest prevalence worldwide reported in - Wrists
Taiwanese aborigines and Maori - Hips
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 • Etiology: - External Fixation

- Pathologic Factors • Pharmacological Management:
- Osteoporosis - Antiresorptive agents
- Cancer - Bone forming agents
- Osteomalacia - NSAIDs
- Osteomyelitis
- Traumatic Fracture Carpal Tunnel Syndrome
- External Causative Factors • Definition:
- Violence/Trauma - Most common entrapment neuropathy
- Direct Violence that causes numbness, tingling, and pain
- Indirect Violence in the hand and forearm as a result of
- Internal Causative Factors the median nerve being squeezed or
- Muscular action compressed as it travels through the
• Pathophysiology: wrist
• Epidemiology:
- More frequent in females
Break in the continuity of the bone - Frequently diagnosed between the ages
↓
of 30 and 60
Surrounding soft tissues and vessels are damaged
↓
- More common in desk-jobs such as call
Extravasation or leakage of blood in the area center agents,
↓ • Etiology:
Neighbouring small vessels dilate and hyperemia - Hereditary
results and the area affected is invaded by - Repetitive Hand use
inflammatory cells
↓
- Hand and wrist position
Inflammation - Pregnancy
- Health Conditions
• Pathophysiology:
• Clinical Manifestations:
- Pain
- Deformity Due to etiological factors (E.g anatomical
- Loss of motion malformation, infection, obesity, diabetes mellitus
etc)
- Crepitus ↓
- Swelling Synovium swollen
- Bruising or Ecchymosis ↓
• Complications:

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Pressure on the median nerve
- Life-threatening complications: ↓
- Vascular damage Temporary blockage of myelinated nerve fibers
↓
- Pneumothorax Sensory changes
- Pneumonia, Thromboembolic disease/
Rhabdomyolysis
- Local complications: • Clinical Manifestations:
- Compartment syndrome may lead to - Numbness, tingling and burning pain-
Volkmann's Ischemia primarily in the thumb and index, middle
- Wound infection and ring fingers
- Systemic complications - Occasional shock-like sensations that
- Fat embolism radiate to the thumb and index, middle
- Hypovolemic shock and ring fingers
• Medical/Surgical Management: - Pain or tingling that may travel up the
- Non-operative Therapy forearm toward the shoulder
- Casting - Weakness and clumsiness in the hand
- Traction making it difficult to perform fine
- Skin Traction movements
- Buck's extension traction • Complications:
- Bryant's traction - Irreversible median nerve damage,
- Russel's traction leading to permanent impairment and
- Skeletal Traction disability
- Operative Therapy - Chronic wrist and hand pain without
- Open Reduction and Internal Fixation without sympathetic dystrophy
(ORIF) - Atrophy and weakness of the muscles at
- Kirschner wires (K wires) the base of the thumb in the palm of the
- Plates and screws hand
- Intramedullary nails • Medical/Surgical Management:

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 - Open carpal tunnel release - Is pain, muscle tension, or stiffness

- Endoscopic carpal tunnel release localised below the costal margin and
• Pharmacological Management: above the inferior gluteal folds, with or
- NSAIDs without sciatics, and is defined as chronic
- Steroid injections when it persists for 12 weeks or more
• Epidemiology:
Osteoporosis - Common in adult populations in low-and
• Definition: middle-income countries
- Bone disease that develops when the - Common in jobs that require heavy
bone mineral density and bone mass manual labour and material-handling
decreases, or when the quality or activities
structure of bone changes leading to a - Injuries to the back are highest among
decrease in bone strength and increase in truck drivers, operators of heavy
risk for fractures equipment and construction workers
• Epidemiology: • Etiology:
- Most common in older women (over age - Muscle or ligament strain
65) - Disc pathologies
- Most common in non-Hispanic whites - Arthritis
women and Asian women - Osteoporosis
- Among men, it is more common in non- • Pathophysiology:
Hispanic whites
• Etiology:
- Estrogen deficiencies in women Alteration in biomechanical properties of the
disk structure, sensitization of nerve endings
- Calcium deficiencies by release of chemical mediators, and
- Inactive lifestyle neurovascular ingrowth into the degenerated
- Steroids and other medications discs
• Pathophysiology: ↓
Low back pain

Bone loss due to normal age-related changes in • Clinical Manifestations:

bone remodelling as well as extrinsic and intrinsic - Dull or achy pain contained to the low
fators that exaggerate the process
↓ back
After age 30 to 45, the resorption and formation - Stinging, burning pain that moves from
processes become imbalanced, and resorption the low back to the backs of the thighs,

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exceeds formation sometimes into the lower legs or feet;
↓ can include numbness or tingling
Excessive bone loss can be due to an increase in
osteoclastic activity and/or osteoblastic activity
(sciatica)
↓ - Muscle spasms and tightness in the low
Osteoporosis back, pelvis and hips
- Pain that worsens after prolonged sitting
or standing
• Clinical Manifestations: - Difficulty standing up straight, walking, or
- Back pain, caused by a fractured or going from standing to sitting
collapsed vertebra • Complications:
- Loss of height over time - Nerve Damage
- A stooped posture - Loss of Work due to Disability
- A bone that breaks much more easily - Weight Gain
than expected - Depression
• Complications: - Insomnia
- Bone fractures particularly in the spine or • Medical/Surgical Management:
hip - Decompression Surgery
• Medical/Surgical Management: - Microdiscectomy
- Vertebroplasty - Laminectomy
- Kyphoplasty - Lumbar spinal fusion surgery
• Pharmacological Management: • Pharmacological Management:
- Bisphosphonates - NSAIDs
- Calcitonin - Muscle relaxants (Baclofen)
- Estrogen and hormone therapy - Opioid Narcotics
- Antidepressants
Low Back Pain
• Definition: Sarcopenia
• Definition:

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 - An age-related decrease of skeletal - At present, resistance exercise, protein

muscle mass and function accompanied supplementation, and vitamin D have
by physical inactivity, decreased mobility, been established as the basic treatment
slow gait, and poor physical endurance of sarcopenia.
which are also common features of the
frailty syndrome
• Epidemiology:
- Common among aged 60 and 80
- Affects both men and women equally
- Prevalence of sarcopenia is greater in
patients with chronic diseases such as
COPD, CHF, CKD, DM, HIV and cancer.
• Etiology:
- Generally attributable to the natural
processes of aging. Factors contributing
to its development include:
- Decreased Type 2 muscle fiber size
and number
- Inactivity
- Obesity
- Insulin resistance
- Reduced androgen and growth factor
serum concentrations
- Inadequate protein intake
- Blunted muscle protein synthesis
(MPS) response to protein meals or
resistance exercise.
• Pathophysiology:

Aging
↓
Senescence of muscle satellite cells
Decrease in the number of muscle satellite cells
Infiltration of inflammatory cells

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Oxidative stress
Mitochondrial dysfunction and insulin resistance
↓
Skeletal muscle protein degradation exceeds
synthesis
↓
Sarcopenia

• Clinical Manifestations:
- Falling
- Muscle weakness
- Slow walking speed
- Self-reported muscle wasting
- Difficulty performing normal daily
activities
• Complications:
- Raises the risk of falls and fractures
- Increases the need for and the length of
hospitalizations
- Increases complications post-surgery
- Raises the risk of death
• Medical/Surgical Management:
- None
• Pharmacological Management:
- No US Food and Drug Administration
(FDA)-approved drugs have been
approved yet for the treatment of
sarcopenia.

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CDU. Using this document for other purposes, please email me at cdu.daniellevalerietabel@gmail.com