MUSCULO SKELETAL AGING
AGE RELATED BONES AND JOINTS
LOWER LIMBS
Correction of not alligned bones, to make a leg more straight -both O and X shaped legs os an osteotomy. Ideal for younger patients (from 45 to 55 years old) with reasonably preserved cartilage tissues Contrindications are smoking, obesity (BMI >30, inflamatory arthritis, patellofemoral symptoms). Usually goes well, the most common complication is stiffness, therefore post operative rehabilitation with physio is helpful.
Morton’s neuroma — often in middle aged women, particularly wearing high heals.
Calcaneal stress fracture – usually from overactivity.
Tarsal Tunnel syndrome – “bottleneck” in the ankle joint is narrow and pinch the nerve-vessels bunch on the way to foot, causing numbness in pain.
Achilles rupture – from sudden jumping movement (often in tennis) on a background of degenerative changes.
HANDS
“wear and tear”. Over age of 70 – 70% of people have arthritis in hands.
Carpal Tunnel Syndrome – clinical test, but can be accompanies with nerve conduction tests (usually in more advised cases, when surgery is required). Conservative management include assessment of underlying cause, splints, cortisone injections( for patients who can’t effort downtime, busy at work, pregnant, need relief as soon as possible, but not for long term solution). Analgesia is generally very unhelpful. Surgery of carpal tunnel release in advanced cases (return to normal function is not expected, but rather improvement of function, Nerve recovery takes up to 2 years).
Flexor tenosynovitis (“trigger finger”) – stiffness and soreness in the finger. Trick is that although pain in the finger, the mechanical problem causing it and most tenderness on palpation is actually on the palm, where the finger’ tendon is caught and stuck within the narrowed outgoing channel. Xray and Ultrasound can prove the diagnoses (beauty of ultrasound that the operator can assess the problem in movement). Cortisol injection into the narrowed region, causing the problem will almost certainly release the problem for some time – usually few months or longer. At early stage and with the 1st injection – over 70% success, but if the problem returns and persists, further cortisol injections only successful in 20%. Cortisol injection is simple and safe, but not permanent solution. Surgery usually resolves the problem in a longer way.
Osteoarthritis (wear and tear join surfaces) – almost certainly appears if person is living long enough. Clicking and cracking on movement is an early sign. Activity modifications, aids, analgesia are preferable methods. Surgery (fusion, arthroplasty) are not as great for hands, commonly leaving patient with stiffness, although relieving the pain.
Thumb CMC arhtritis – most common. Base of the thumb is almost always degenerate. The trick is that Xray chnages doesn’t correlate with clinical pain. Management: Splints, Analgesia, cortisone injections, activity modifications. Surgery – suspensionplasty is a gold standard, but also fusion, implant arthroplasty can be used.
SLAC wrist arthristis is more proximal. Most have history of trauma in the past of distal radius, scaphoid or lunear bones.
De Quevains’s tendonitis
Dupuytren’s contracture – lump slowly increasing in the palm. Management is observation until causes discomfort. If patient placed palm on the table and finger is elevated -that usually when it is clinically bothering patients. When contracture is MCP proximal (close to palm) – they usually respond well to collagenase injections (Xiaflex), but they are expensive with no rebates. Downtime is around 1-2 weeks, when patient can come back to activities and work. Surgery is a lot of more huslle, taking around 3 months downtime, but the main option for cases when proximal joints of fingers involved.
Ganglion – cystic, fluid filled lesion form repetitive overuse.
Inclusion cyst (“bump”) after trauma.
Mucous cyst – clinical clear diagnoses of lumps growing near nails, sometimes causing nail deformity. Osteoarthritis spurs of the joins grow the fluid filled cyst, which applies a pressure on a nearby tissues. Needle aspiration is rarely fixes the problem as not fixing the cause – which is a leak from the degenerated joint. Surgery debrides the osteophite from the affected joint and clear the cause. Surgery is reasonably easy with downtime around a week (“sausage finger”) with a rare return of the problem.
Management commonly include activity modification, splinting (most of cases should be weared not all the time, but during activities. Hand therapist assist with fitting and finding the most appropriate one), analgesia, anti-inflammatory medication injections into the pain area and surgery.
What are risk factors for osteoporosis (bone loss)?
Family history – parent or sibling
Early menopause
Hypogonadism
≥ 3 months glucocorticoids (at Prednisone ≥ 7.5mg)
Coeliac disease/malabsorption disorders
Rheumatoid arthritis
Primary hyperparathyroidism
Hyperthyroidism
Chronic kidney or liver disease
Androgen deprivation therapy
Recurrent falls
Breast cancer on aromatase inhibitors
Treatment with antiepileptic medications
Low body weight
HIV and its treatment
Major depression/ SSRI treatment
Type 1 and type 2 diabetes mellitus
Multiple myeloma/monoclonal gammopathy
Organ or bone marrow transplant
Treated with glucocorticoids
kidney disease present
