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211 exam 1
Geriatric Orthopedics
| Question | Answer |
|---|---|
| type 1 mm fibers | Slow twitch Fatigue resistant Tend to be postural muscles Oxidizing and endurance |
| type 2 mm fibers | Fast twitch Anaerobic Larger muscles |
| can atrophic changes in the geriatric pop be reversed? | yes, if minimal |
| ____ extremity tends to atrophy more than ____ extremity because many elderly ___ less but still do ADL’s such a brushing hair, getting dress. | lower, upper, walk |
| consequences of atrophy | weakness leading to poor balance and falls |
| how much muscle mass is lost with age? | 30-40% |
| muscle mass loss tends to be ___ specific, muscle ___ themselves get smaller | site, fibers |
| greatest loss of fibers with age is type ____ | 2 |
| there is decrease in ___ ___ velocity with age | nerve conduction (slower to apply break pedal from gas) |
| changes to the muscle with age (3) | - muscle mass loss - loss of type 2 fibers - decrease in nerve conduction velocity |
| what will you see with a loss of type 2 mm fibers | decreased speed, decreased balance reactions, increased falls |
| when does strength peak? | at 30 |
| when does strength begin to decline | after age 50 |
| sinister pathologies | pathologies that present as musculoskeletal issues but aren't, something more serious is going on |
| examples of sinister pathologies | spinal tumors, spinal infections, fractures |
| symptoms of spinal tumors | unexplained wt loss, constant night pain, rapid increasing neck/back pain, dysphagia |
| spinal infection symptoms | fever, dysphagia, UTI, any neurologic changes |
| risk factors for fractures | Hx of corticosteroid use, older than 70y/o |
| night pain vs pain at night | night pain does not go away with position changes, pain at night is relieved with movement |
| what should be avoided in pts who are at risk of fx | significant spinal flexion movement – can cause vertebral body to collapse. |
| signs of spinal cord lesion | difficulty initiating urination, Babinski, increased clonus, clumsiness, loss of dexterity |
| signs of inflammatory arthropathy (systemic arthritis- gout, septic arthritis etc.) | marked morning stiffness that does not get better, Optic disease – Iritis (irritation of the eye) |
| signs of neurological issues | Cranial nerve signs Ptosis pupil constriction |
| vertebral artery vascular issues, 5 D's | Diplopia Dysphagia Drop attacks: look up at the ceiling and blackout Dizziness Dysarthria |
| vertebral artery vascular issues, 3 n's | numbness, nausea, nystagmus. |
| Avoid ___ test in the geriatric, may cause a stroke | VA insufficiency |
| Rotation of the c-spine to ____ cause occlusion of the ___ in the elderly, so only do pressure on/off for rotation past that position. | greater than 45 degrees, VA |
| Degenerative Disc Disease (DDD) | facets close down as the disc loses height causing narrowing of the interforaminal and spinal canals |
| degenerative spondylosis | same as DDD |
| spinal foraminal stenosis | narrowing of the spinal foramen |
| lumbar disc protrusion | some elderly still have nucleus pulposus (not in the C-spine) |
| osteoarthritis is twice as prevalent in ___ over ___ | women, men |
| what procedures/techniques ate safe as long as PT screens for sinister patholgies? | joint mobs (maitland), McKenzie spinal extension, Mulligan |
| McKenzie protocol for geriatrics | The “pressure on/off” tends to be quite safe for the elderly Avoid “peripheralization” also lends well for working with the elderly Avoid end range cervical extension secondary to VA compromise |
| Mulligan techniques for elderly | advocates “no pain” with all techniques which would lend itself to treating the geriatric patient. |
| intent of Maitland (joint mobs/manual) principles | either to produce the pain of a stiffness disorder (and restore normal movement) or eliminate the patient’s dominant pain disorder |
| pts will be ___ dominant or ___ dominant | pain, stiffness |
| pain dominant pt | primary complaint is pain, movement is limited by pain, condition is easily irritated - Grades I & II |
| stiffness dominant pt | primary complaint is stiffness, movement is limited by stiffness, condition is not easily irritated – Grades III & IV |
| derangement | Disc protrusion causing loss of ROM, radicular/referred pain – Centralization of symptoms is rapid |
| dysfunction | Stress applied to shortened/scarred structures, repeated tests produce end-range pain Goal is to elongate shortened tissues, 2-6 wks Treatment - produce pain 2 sec on/ off |
| postural syndrome | the postural fault is causing the pain |
| adherent nerve root | peripheralization of symptoms is warranted. |
| McKenzie's diagnostic principles | derangement, dysfunction, postural syndrome, adherent nerve root, trauma |
| 18 |
Created by:
bdavis53102
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