RS5352 Geriatric Musculoskeletal Conditions PDF

Geriatric Musculoskeletal Conditions RS5352 CSMC2 May 22, 2024 Sam Chan [email protected] Joy Lau [email protected]  Pre-lecture Activities View Video Clip and answer following questions https://www.youtube....

Geriatric Musculoskeletal Conditions RS5352 CSMC2 May 22, 2024 Sam Chan [email protected] Joy Lau [email protected]  Pre-lecture Activities View Video Clip and answer following questions https://www.youtube.com/watch?v=8ZOvoYYxGu0 1. Under what circumstances the head of the femur (and even acetabulum) need to be surgically replaced? Displaced fracture, older age, avascular necrosis of femoral head Displaced fracture Old age Avascular necrosis 2. What is the name of such a surgical operation? Total hip Total hip arthroplasty arthroplasty / replacement / replacement (THR) (THR) 3. What are the possible variations in such an surgical operation? Unipolar vs Bipolar Head: Unipolar vs Bipolar Cemented vs Uncemented Cemented vs uncemented  Geriatrics Gerontology ** // rehabilitative + - · By using related compensatory treatit - to elderly state the teatrats This refers to of elderly study of knowledge M · · The medical approaches Rehabilitation , late eg. mental function ej Lifespan from childhood to age of physical + multidisciplinaryapproache state process of changes. & irreversible It involves entionals S gradual ↑ · It is the natural family make elated conditions · , Lincluding in a comprehensive Gerontology & Geriatrics different + to manage mamen · The declines are unpredictable The study of knowledge of elderly * Gerontology E.g. Lifespan Natural, gradual, irreversible process of changes from childhood to late age Declines are different and unpredictable Refers to treatment related to elderly E Geriatrics E.g. Rehabilitation, medical approaches - E37 ↓ At Multidisciplinary approach, including family members or professionals, to manage age- related conditions in a comprehensive manner Rehabilitative and compensatory treatments to promote the pre- injury state of physical and mental function  in There are changes hi : conditions ③ Tendon Meriatric MSK ② -- Muscle : ① Bones t Joints T : ~ in the elderly - (and related soft tissue) Reduced mass , ligaments problems : · - disabilities of bones , muscles and joints are common Reduced fibers connective · Reduced elasticity Diseases and mass , elaricity · · disabilities tissue t Reduced L significant regeneration · more than 1/3 of · Impaired strength 4 Accounting and health · Brittle · Delayed healing Geriatric Musculoskeletal Conditions Diseases and disabilities of bones, muscles and joints are the common problems in the elderly, accounting more than one-third of significant disabilities. Change in : – Bone and Joints, and Related Soft-tissue Reduced Mass, Impaired Regeneration and Health – Muscles Reduction in Mass, Fibres, Connective Tissue – Tendons and Ligaments Reduced Elasticity and Strength / Brittleness – Skin Thinning, Reduced Elasticity and Delayed Healing  types of Geriatric MSK conditions eg#3 pecubitus ulcer eg#1 Osteoporosis : There > ③ Metabolic I are cam. / E (pressure sore pressure now 6 I body density - Wear & Tear) : blood ea 6. Inside the where bone ① Traumatic: ② Overuse Jaka > Total knee replacement dona This allected lessen replenishment can't is much lower Osteoarthritis of knee when aka lying · egH) painful keep up/ compensate eg#2 Gout th to · Fractures in elderly (more sore &. of ita adus) skin replacement (Damage to flammatoryauthritis, fracture & distal r i a n area eg. Colles' Fracture Jaka eg#2 Osteoarthritis of hip especially , , · - Osteoporosis Osteoporotic Fractures to are more prone : to · It would lead ① weaker bone structure ② Decreased bone density ③ Increased brittleness Aka spongy bone Trabecular bone, esp. vertebrae, hips, & wrists are more prone to osteoporosis S Weaker bone structure, decreased bone density and increased brittleness More prone to to fractures, even due to low-impact injury or one’s weight. 1 in 39 % (39,7%) will suffer at least one of the these fractures  further bone loss Treatments for Osteoporosis or must be · To prevent exercise · Dietary deficiencies rebuild some of the · Encourage weight bearing - vertebral collapse fracture connected possibly for reducing risk of fracture femoral neck fracture stimulated by Complications Leg or is lost bone. · nuscle strength + balanch must be treated doses of and improving giving large ↳ vitamin D. eg Vertebroplasty calcium + Treatments for Osteoporosis that La procedure cement into injers cement ingers - cracked broken a or that I broken bone to help Treatment cracked bone to spinal a - into pain relieve pain) Treatments for Osteoporosis line ↑ : - vertebral collapse facture) ST be treeted leg. Vertebroplasty) Femoral neck fracture Complications Leg or Complications (femoral neck. · be corrected deficiencies must of the lost bone · Dietary build some possibly fracture or vertebral collapse bone loss strength or D + Calcium Prevent further dose of Vitamin muscle · stimulated by ging large risk of free t for reducing t fracture) must be treated. E.g. is 4 This exercise weight beans balacl · Encourage vertebroplasty Aka a treatment that injects cement into a cracked or broken spinal bone to help relieve pain Dietary deficiencies must be corrected. Prevent further bone loss or possibly rebuild some of the lost bone is stimulated by giving large doses of calcium and vitamin D Encourage weight bearing exercise for reducing risk of fracture and improving muscle strength and balance Osteoarthritis (PE) breakdown t repair of articular cartilage. refers to the simultaneous + progressive Osteoarthritis that tissue properties of · poor healing. because of the Osteoarthritis (E) Cartilaginous degeneration occurs · entirely repaired + is not to the cartilage Damage · accumulates with age 1 of Osteoarthritis : * Step - degeneration of cartilage I Damage Simultaneous and progressive breakdown and repair of articular cartilage Cartilaginous degeneration occurs because of the poor healing properties of that tissue Damage to the cartilage is not entirely repaired and accumulates with aging Osteoarthritis ([i] & ) breakdow + repair of articular simultaneous + progressive Osteoarthritis: refers to the · Osteoarthritis cartilage Step 1: Damage / degeneration of cartilage of that tissue occus because of the poor healing properties · Cartilagious degeneration and acculates to that cartilage is not entirely repaired with · Damage age 1 of Otexarthritis : Damage / degeneration * Step of cartilage  S ③ Irabeculat Osteophyte formation ① Synorium joint ②Subchondral plate Development of + Normal : Osteoarthritis I magn ↑ aka (Dona spars) are caused thin colum cal - · Damaged + plates of bones. Bone cyst formation · Fibrous ·Nor first ↓ then Vascularization inflammation > - blood vessels · Decreased , that create spongy · Sclerosis due to process of going need thinkwe structure in Cancellous casified cartilage Major changes · Lake hollowhea the , improve exygen- nutie bone · into time to is des just ↑ a I · Subchondral plate aup : nothing Development of Osteoarthritis &Fall a · Subchondra) trabecul - · Subchondral microdamage · ↓ Subchondral plate to thicknes Major changes due localized porosity 1 ↑ Subchandra inflammation and The vascularization · deterioration ↓ process of growing blood vessels into a Cartilage tissue to improve oxygen and nutrient supply – Surface erosion with fissure – Calcification The process in which calcium builds up, causing the tissue to harden · The eroded area would facilitate the - with the Subcondral plate eat-up process Aka a thin layer of cortical ③ bone lying immediately OA - : – Damaged Osteoclast beneath the calcified Progressive Cartilage aa · thesametime Butat cartilage (?) · a desination proper That's why area when the orteoblast – Decreased then increased · ↑cacified carriage (part of · the builds up bone the remodeling process callus thickness thickness tidemark Reduplicated · Aka the thin columns and plates a Trabeculae the ↳ It's actually building at of bone that create a spongy wrong place ↑ Subchondral · be Breadin to some areas structure in a cancellous bone thickness plate – Osteophyte formation other thicker , bony layers bone Subchondral Cartilage has been eroded · * This leads to – Bone Cyst formation cyst present Subcondral nimodauage Oreoarthritis · – Sclerosis S plate subcondral Subchondro) · trabecular · The malctition e sclerosis receases , Synovium Where the joint would be totally dysfunctional · Wheban, without anything – Fibrotic The eroded area would facilitate the osteoclast to do the eat-up process But at the same time, the osteoblast CANNOT settle in a proper area That’s why when the osteoblast build up the callus (part of the bone remodelling process), it is actually building at the wrong position (leading to some areas being thicker and some with less bony layers) This leads to osteoarthritis Arthritis Research & Therapy (2013) 15:223 The subchondral plate thickness increases, and malnutrition over the layers, the subchondral bone cyst doesn’t have anything (just a hollow hole, without anything)  And the knee joint to function & Clinical presentation Osteoarthritis of e X-Ray Knee Joint Wear and Tear : : Caused by · ↑ · Fractures of the knee + torn ligaments abnormally overweight of Uneven him - Angulation leg knee) · · & of the joint unface irregularity X be COA can cause ↳ which should Osteoarthritis of Knee Joint white > - Signifying Osteophyte Clinical presentation X-Ray (“OA Knee”) Angulation O & Caused by ‘wear and tear’ Uneven rim Fractures of the knee and torn ligaments can cause G ( irregularity of the joint Proximal part of the tibial plateau surface and the knee joint to function abnormally overweight It should not be white and uneven This is osteophyte Nature Reviews Rheumatology volume 9, pages225–235(2013)  of Knee Joint Asteoarthritis : If OA knee is left untreated Qsymptoms : It would lead to imbalance of weight · · Slowlyinitatinga apal worsened with movement but relieved with rest Morning stiffness + , reduced Clinical Features bearing Cause hip pain and collapse of spine (L4-5) If flat feet left untreated: · Osteoarthritis of Knee Joint - daily activity Observation ②- May lead to OA knee : > pain - - & relies Antalgicgitsedud and OA hip · limping/shuffling gait) + Swelling · Effusion Symptom NOT sharp pain Movement and / Slowly increasing pain in the joint Joint laxity Aka looseness or instability of a joint or Bursitis Worsened with movement and relieved Restricted ROM and reduced muscle · Quadriceps wasting is noticeable Aka existing at the same time · Valgus/Vais with rest strength with concomitant crepitation Aka crackling sound deformity may occur Morning stiffness; reduced daily activites (due to the narrowing cartilage space and (often with Observation to osteophytes at the joint) inability Aka pain-relieving straighten Antalgic “pain-induced limping” (or l a tel shuffling) gait Antalgic gait 減痛步態: One of the most common forms of altered gait in patients; an abnormal pattern of walking secondary to pain, which causes a limp ·Increased Swelling and Effusion and/or bursitis temperature Aka an abnormal collection of fluid in hollow spaces (Her wo Quadriceps wasting is noticeable + acute) · Tenderness or Pain Valgus or varus deformity may occur, · Uneven often with inability to straighten the knee bone or sufall joint fully Feel warmth when palpation oreophyt aPalpation If it’s very warm, it would Joint · laxity Increased temperature be at acute phase looseness/ - instability Tenderness or pain restricted Uneven bone or joint surface · ROM + reduced muscle strength concomitant with (osteophytes) x & (evising crepitation Some time) sound (crackling ↳ Due to naming cartilage space + & osteophytes that feel * If left intreated al the joint How do you report results of your observation 4 May lead to *HOAweDetected weight bearing and physical examination on the medical notes? OA knee + collapse of spire (24-5) causing hip pain ↳ + hip Q Angle gives insight about whether a patient has OA knee Q Angle for Knee Joint Alignment Angle formed a line drawn from the ASIS to the central patella and the second line drawn from the central patella to tibial tubercle Indicator for risk for patellar of OA knee QAngle for Knee joint Alignment : Normal range: make - whether insight on · Q Angle providesOA knee male: 14 degrees · a patient Angle formed from has a line dramm central from patella Female: 17 degrees the the Asls to line from Central 6 And the second twherche/tuberosity patella to tibial Increase Q angle: · It is an indicator for risk for patella of · OA kull Genu valgum · Normal range > - Female : : 170 Decreased Q angle: + Male : Increased Q angle 140 : Genu varum · > - Genu Valgum) · Decreased Q angle : > - Genu Varum - Analgesics ↳ Non-steroidal ↳ Painkillen Anti-inflammatory for bed-bound drugs Operation is indicated if conservative tualment fails : ② Arthrodesis (joint fusion) - Very rare Cusually patients) - Intensive active exercises wasted quadricep muscle flexion/extension S operations Joint do are carried out to shengthen the are 3 main : · can no longer There - Rarely performed now · (5) Quite race · 4 Refer to PT to strengthen muscle Upper Tibial Osteotomy as a - ① - correction of malalignment by the removal of wedge of bone a · But may be severa appropriatein · fail C degenerative process Treatment awest the · This often relieves pain + can Lif it is performed early ③ Arthroplasty (Total Knee replacement) commonly performed Conservative treatment · Most Aka painkiller medications Non-steroidal anti-inflammatory drugs – Analgesics and NSAIDs – Intensive active exercises are carried out to strengthen the wasted quadriceps muscle Refer to PT to strengthen muscle Operation is indicated if the conservative treatment fails – Three main operations- 截⾻術 1. Upper tibial Osteotomy (correction of the mal-alignment by the removal of Quite rare a wedge of bone) Aka stop often relieves pain and can arrest the degenerative process if it is early performed.- 關節固定⼿術 This is usually for 2. Arthrodesis Very rare, related to joint fusion, so the joint can no longer do flexion or extension patients who are – Now rarely performed bed bound – But may be appropriate in severe case such as when the other operations have failed. 3. Arthroplasty (e.g. total knee replacement) – Mostly commonly performed Upper Tibial - Osteotomy - Cut off the proximal part of the tibia Suitable for very dependent case, or those who · A medge is To promote even distribution of weight bearing cannot do functional tasks removed and aligment is corrected proximal Arthrodesis - · Cut off the part of tibin Joint fusion distribution ↳ To promote even · of weight bearing · For dependent patients leg- bed-bound) or , X do those who functional tasks Femoral part is metal Arthroplasty (Total Knee replacement) Tibial part is plastic - areofdiferent mar as planin] They metal Femoral part : · - They are different because if · Tibial part : 4 even more friction both parts are metal, it would 磨損 even more Metal x plastic combo would have less friction Total Knee Replacement Osteoarthritis - on Hip Joint (OAHip) · Relief from OAhip the work of a now makes a considerable outhropaedic surgeon part of A Hip :· & Decreased joint space bon Common cause for serve disablement (especially in the elderly · Rough Osteoarthritis of · · wom varistage Hip Joint (“OA Hip”) Common cause of severe disablement, especially in the elderly Relief from O.A. of the hip now makes a considerable part of the work of an orthopaedic surgeon.  Features of OA Hip Movements : Minical - of hip (240-50 % as normal IR + ER · PROM ange) Symptoms roll (Freiburg Test) Internal rotate - Log : · medial thigh up limb ( ) feelt & groin , buttock - or Clinical Features pain weight-bearing ? on suchondral · acute hip pain de to cyst · FABER (Patrick) Test Some patients may experience & · rupture in the jout > Digit "4" &