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Musculoskeletal conditions. Ahmad Osailan. Common changes in musculoskeletal system due to aging. Dehydration of disc causes reduction in total height by 1 cm in 10 yrs Muscle weakness contributes to fatigue, weakness, and reduced activity.

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common changes in musculoskeletal system due to aging
Common changes in musculoskeletal system due to aging
  • Dehydration of disc causes reduction in total height by 1 cm in 10 yrs
  • Muscle weakness contributes to fatigue, weakness, and reduced activity.
  • The foot arches become less pronounced, causing a slight loss of height.
  • Hip and knee joints may begin to lose joint cartilage (degenerative changes).
  • The finger joints lose cartilage and the bones thicken slightly. Finger joint changes are more common in women.
  • Osteoporosis is a bone disease characterised by reduction of bone tissue relative to volume of anatomical bone.
  • This increases susceptibility to fracture.
  • In osteoporosis, the bone is of normal size, but contains less bone tissue, with no change in ratio of mineral content to organic material.
  • In osteomalacia, the amount of bone can be normal or increased, but has reduced mineral content
  • Most common complications and fractures resulting from osteoarthritis:
  • Hip fracture,
  • Vertebral fracture,
  • distal radial fracture
  • humeral neck fracture
  • Postural deformities
  • Predisposing factors:
    • Sedentary living
    • Inadequate estrogen
    • Underweight
    • Low calcium intake

Common in geriatric population

Primary generalised OA –affects hands with formation of Heberden’s & Bouchard’s Nodes

Mostly affects the knees, hips and spine

Pain, deformity and decreased mobility

  • Stiffness, tenderness, crepitus and enlargement develop.
  • Deformity, incomplete dislocation and synovial effusion may eventually occur.
  • Treatment: rest, heat, ice, anti inflammatory drugs, decrease wt. if indicated, injectable corticosteroids, surgery.
clinical manifestations osteoarthritis
Clinical Manifestations (osteoarthritis)

Heberden’s Nodes

Appears in bothmen and women

Located at the distalinterphalangeal joints

Appears on both hands

May be painful and red

Tend to be familial and of cosmetic concern

Feel hard and cause tenderness when palpated

clinical manifestations continued
Clinical Manifestations (continued)

Bouchard’s nodes

Same manifestations as Heberden’s nodes except:

Bouchard’s nodes are located at the proximal interphalangeal joints

spine oa
Spine OA
  • Degenerative disease of the spine can involve the
    • apophyseal joint
    • intervertebral disks
    • paraspinous ligaments.
  • Spondylosis refers to degenerative disk disease.
spine oa1
Spine OA
  • The diagnosis of spinal OA should be reserved for patients with involvement of the apophyseal joints and not only disk degeneration.
  • Symptoms of spinal OA include
    • localized pain and stiffness
    • Nerve root compression by an
      • osteophyte blocking a neural foramen
      • prolapse of a degenerated disk
      • or subluxation of an apophyseal joint may cause radicular pain and motor weakness.
degenerative changes in the spine definitions
Degenerative changes in the spine- Definitions:
  • Apophyseal joint- the joint around a bone that has no independent ossification
  • Spondylosis- ankylosis (stiffening) of the vertebrae (this term is often used very generally to refer to any degenerative back problem)
  • Spondylolysis- degeneration of the articulating part of the vertebrae (the classic OA change)
  • Spondylolisthesis- forward movement of the body of one of the lower vertebrae on the vertebrae below it
  • Spondylitis- inflammation of one or more of the vertebral bodies (infection [TB] or inflammatory disease [RA])
osteoarthritis risk factors
Osteoarthritis- Risk Factors


Decreased muscle strength


Possible genetic risk

Early in disease process, OA is difficult to dx from RA

Hx of Trauma to joint

oa signs and symptoms
OA- Signs and Symptoms

Joint pain and stiffness that resolves with rest or inactivity

Pain with joint palpation or ROJM

Crepitus in one or more joints

Enlarged joints

Heberden’s nodes enlarged at distal IP joints

Bouchard’s nodes located at proximal IP joints

what to assess for
What to assess for:

ESR, Xrays, CT acans

Degree of functional limitation

Levels of pain/fatigue after activity

Range of motion

Proper function/joint alignment

Home barriers and ability to perform ADLs

rehabilitation interventions

Patient education

Rest, Exercise, Ergonomics

Physical Modalities

Orthosis, Assistive devices & Ambulatory aids

Environmental modifications

Surgery & post-surgery rehabilitation

rheumatoid arthritis
Rheumatoid Arthritis

Chronic, systemic, progressive inflammatory disease of the synovial tissue, bilateral, involving numerous joints.

Synovitis-warm, red, swollen joints resulting from accumulation of fluid and inflammatory cells.

Classified as autoimmune process

Can cause severe deformities that restrict function

ra risk factors
RA- Risk Factors

Female gender

Age 20-50 years

Genetic predisposition

Epstein Barr virus


ra signs and symptoms
RA – Signs and Symptoms

Joints- bilateral and symmetric stiffness, tenderness, swelling and temp. changes in joint.

Pain at rest and with movement

Pulses- check peripheral pulses,

Edema- observe, location of edema.

ROM, muscle strength, mobility, atrophy

Anorexia, weight loss


complications of ra
Complications of RA

Joint deformity


Cervical subluxation

gouty arthritis
Gouty Arthritis

Very painful joint inflammation, swollen and reddened

Primary-Inborn error of uric acid metabolism- increases production and interferes with excretion of uric acid

Secondary- Hyperuricemia caused by another disease

Excess uric acid – converted to sodium urate crystals and precipitate from blood and become deposited in joints- tophi or in kidneys, renal calculi


Meds- colchicine, NSAIDS, Indocin (indomethacin), glucocorticoid drugs,

Allopurinol, Probenecid-reduce uric acid levels

Diet- excludes purine rich foods, such as organ meats, anchovies, sardines, lentils, sweetbreads,red wine

Avoid diuretics- may precipitate attacks

  • Rest, during day- decrease wt. bearing stress.
  • ROM- maintain joint function, exercise –water.
  • Ultrasound, diathermy, hot and cold applications
  • Surgical- Synovectomy, Arthroplasty, Total hip replacement.