Topic 9_-_orthopaedic_degenerative

Orthopaedic Degenerative Conditions

1. Osteoporosis

Definition

Osteoporosis is a disease characterized by fragile and brittle bones due to a loss of bone mass or minerals, resulting in lower than normal bone mineral density (BMD).

Fracture Risk

Osteoporosis increases vulnerability to fractures from falls or bumps; affects half of all women and one-third of men over 60 in Australia.

Commonly Affected Bones

  • Hip

  • Spine

  • Wrist

  • Ribs

  • Pelvis

  • Upper arm

Asymptomatic Nature

Often remains undetected until a fracture occurs; characterized by lower than normal bone mass for age and gender.

Bone Structure Changes

Thinning of the bone cortex and sparser trabeculae compared to normal bone.

Bone Density Measurement

The T-score measures deviations in BMD from a young adult's normal BMD to identify individuals at risk.

Risk Factors

Changeable Risk Factors

  • Sedentary lifestyle

  • Smoking

  • High alcohol consumption

  • Low body weight

  • Inadequate calcium intake

  • Frequent falls

Non-changeable Risk Factors

  • Family history

  • Gender

  • Ethnicity

  • Delayed puberty or early menopause

  • Previous fractures

  • Diseases like rheumatoid arthritis or chronic liver disease

  • Overactive thyroid conditions

  • Low testosterone in males

  • Prolonged corticosteroid use

Therapeutic Interventions

Include hormone replacement therapy (HRT), calcium and vitamin D supplements, and exercise.

Goals of Treatment

The primary goal of treatment is to reduce fracture risk by minimizing bone loss and increasing bone mass.

2. Exercise and Bone Health

Exercise Goals

Vary over a person's lifespan, focusing on specific developmental needs:

Childhood and Adolescence

  • Objective: Building maximum bone strength during rapid skeletal growth.

  • Activities: Engage in weight-bearing exercises such as jumping, running, and resistance training to increase bone density and strength.

  • Importance: Critical period for accumulating bone mass, providing a protective buffer against osteoporosis later in life.

Young Adulthood

  • Objective: Optimizing muscle and bone strength.

  • Activities: Incorporate a balance of resistance training, aerobic exercises, and sport-specific activities to maintain peak bone mass.

  • Importance: Vital to establish lifelong exercise habits that maintain bone health.

Middle Age

  • Objective: Preventing bone loss and maintaining muscle mass.

  • Activities: Continue strength training, aerobic activities, and include flexibility and balance exercises to reduce fall risks.

  • Importance: Gradual decline in bone density begins, making exercise crucial to mitigate loss.

Older Age

  • Objective: Reducing bone loss, preventing sarcopenia (loss of muscle mass), addressing frailty, and minimizing risks of falls and mobility issues.

  • Activities: Emphasize low-impact exercises such as walking, swimming, and tai chi, alongside weight training.

  • Importance: Essential for maintaining functional independence and quality of life while minimizing fracture risk.

3. Osteoarthritis

3.1 Overview

Definition

A degenerative joint disorder characterized by the progressive loss of articular cartilage, new bone formation, and capsular fibrosis.

Causes

  • Primary: No apparent cause.

  • Secondary: Resulting from injury.

Aging vs. Osteoarthritis

OA is described as a disorder, not a normal consequence of aging.

3.2 Pathophysiology and Impact

Causal Factors

Include joint deformities, prior cartilage disorders, and abnormal subarticular bone.

Affected Areas

Mainly impacts weight-bearing joints, with long-term development evident in the elderly.

Pathology Features

Includes:

  • Cartilage destruction

  • Subarticular cyst formation

  • Osteophyte formation

  • Capsular fibrosis

3.3 Exercise for Osteoarthritis Rehabilitation

Goals

  • Prevent or reduce disability.

  • Preserve or improve musculoskeletal function.

  • Minimize joint stress.

Objectives

Enhance cardiovascular health, flexibility, muscle strength, and endurance.

Types of Exercise

  • Range of Motion (ROM) Exercises: Ensure range of motion; includes assessments and controlled stretching techniques.

  • Strengthening Exercises: Initially isometric, progressing to isotonic with light weights to prevent disuse atrophy and enhance muscle shock absorption.

  • Cardiovascular Conditioning: Engage in low-impact activities such as swimming, cycling, and walking.

4. Rheumatoid Arthritis

4.1 Characteristics

Nature

A systemic disease affecting connective tissues, leading to chronic pain, swelling, and tenderness in joints and tendon sheaths.

Pathology Stages

  • Stage 1: Synovitis and joint swelling.

  • Stage 2: Early joint destruction with erosions.

  • Stage 3: Advanced destruction and joint deformity.

4.2 Functional Impairment and Rehabilitation

Functional Challenges

Resulting from diminished joint function, muscle weakness, and poor conditioning.

Exercise Benefits

Improves subjective strength and reduces tiredness.

Exercise Guidelines

  • Similar rehabilitation approach as for OA, adjusting volume if symptoms worsen.

  • Incorporate rest during active inflammation episodes; prioritize functional improvement over drastic strength or flexibility increases.

5. Typical Exam Questions

  • Define osteoporosis.

  • Describe appropriate exercise types for clients with osteoarthritis and justify your response.