Orthopedics is the medical specialty that focuses on diagnosis and treatment of injuries, conditions and diseases of the body’s musculoskeletal system. This complex system includes one’s joints, bones, tendons, ligaments, muscles and nerves which enables an individual to work, move and be active. A medical doctor who practices orthopedics is referred to as an orthopedic doctor/specialist, orthopedist or orthopedic surgeon. Orthopedists diagnose musculoskeletal issues, determine appropriate methods of treatment and aid in the rehabilitation of injured or deformed bone structures. There are several areas of orthopedics that an orthopedist may specialize in including the spine, foot and ankle, hip or knee. Others may focus on trauma, pediatrics or sports medicine.
Orthopedic surgeons are those who specialize in surgery on the musculoskeletal system. Musculoskeletal injuries and diseases among the senior population have presented major challenges for orthopedic surgeons because the older individuals have soft tissue and bone quality which is somewhat different than that found in younger orthopedic patients. Aged skin and softer tissues are generally fragile and less tolerant to surgical trauma. In most instances, surgery is not recommended for seniors because they often have other medical issues such as diabetes mellitus, hypertension, vascular disorders, cancer and/or dementia that can pose increased risks from surgery.
The most common surgeries performed by orthopedic surgeons are arthroscopy, joint replacements, soft tissue repair, fusions with bone grafts and rods, internal fixations and correcting bone deformities. The main goal of any orthopedic treatment for seniors is to return them to an independent life, including basic activities of daily living such as walking, dressing, eating and toilet functions.
There are many common orthopedic conditions that most seniors must learn to contend with, including:
Arthritis. Arthritis is the inflammation (swelling) of one or more joints in the body. Joints are where two bones meet. Arthritis involves the breakdown of cartilage at the joint. Cartilage is a flexible connective tissue that covers the ends of bones at the joint. Cartilage helps protects the joint by allowing bones to move smoothly over one another with the help of synovial fluid. It is also what absorbs shock when there is pressure placed on the joint, such as when a person walks or runs. When the cartilage wears down and there is no longer a normal amount if it at the joints, it can cause stiffness, pain and inflammation. Joint inflammation can be a result of:
- an autoimmune disease where the body’s immune system mistakenly attacks healthy tissue;
- broken bone(s) or injury;
- infection, usually from bacterial or viral infections;
- general “wear and tear” on joints as a result of age and use.
Once the cause of the arthritis is treated it will usually go away. However, sometimes it does not. When arthritis does not go away after treatment it is considered to be chronic arthritis. Treatments for most forms of arthritis may include lifestyle changes, physical therapy, exercise, medication and/or surgeries. Arthritis isn’t just the aches and pains that a person gets as a result of getting older. Arthritis is a serious disease. About two-thirds of people with arthritis are under the age of 65, including 300,000 children. Arthritis accounts for 44 million outpatient visits and 992,100 hospitalizations and is the leading cause of disability in America. In fact, out of heart disease, cancer and diabetes combined, arthritis is the most common cause of limitations to daily activities. Arthritis is not just one disorder it is actually a complex group of musculoskeletal disorders that destroy joints, muscles, cartilage, bones, and other connective tissues. There are more than 100 different arthritic diseases or conditions that can affect people of all ages, genders, and races. Some of the most common diseases that make up arthritis in the elderly include osteoarthritis, gout, and rheumatoid, psoriatic and infectious arthritis. (See: ARTHRITIS)
Of particular concern to seniors is osteoarthritis. When one suffers from osteoarthritis, the joint cartilage wears away, making everything from opening a jar to answering the door and endurance test. Osteoarthritis is a joint disease that gets worse over time and is characterized by the breakdown of joint cartilage due to normal wear and tear and age. If the cartilage breaks down and wears away, the bones rub together. This breakdown of cartilage causes pain, swelling and stiffness. The cause of osteoarthritis is unknown but it is mainly related to the aging process. Osteoarthritis general appears in middle age and, prior to age 55, it occurs equally in women and men. However, after the age of 55, it is more likely to be seen in women. Minor symptoms of osteoarthritis are commonly seen in most people over the age of 70.
Among the senior population, osteoarthritis is usually found in the hip, spine and knee joints. Treatments for osteoarthritis may include medications, exercise, weight control, joint protection, physical therapy (PT) and/or occupational therapy (OT). Alternative therapies such as massage, acupuncture and acupressure may be of benefit to those suffering from osteoarthritis, as the improved circulation and warmth often helps to relax the stressed joints.
Osteoporosis. When one suffers from osteoporosis, their bones become brittle, porous and fragile, and tend to break easily. Fractures are not uncommon and those of the hip pose a special danger to seniors, as fragile bones can break with the slightest pressure and cannot knit themselves back together. Osteoporosis can happen to anyone, but it is more commonly found in older women because females tend to have smaller more frail bones. Those particularly at risk are older women of white or Asian descent. Half of all women and a quarter of men who are older than 50 will break a bone due to osteoporosis. A person may not even be aware that they have osteoporosis until after they have broken a bone. Because of this, a bone mineral density test is recommended. Treatments for osteoporosis may include medications, exercise, fall prevention therapies, vitamins and lifestyle changes.
Rotator cuff tears. The rotator cuff is a group of tendons that keep your shoulder in its socket. These tendons are subject to a lot of wear and tear, or degeneration, as we use our arms. Tearing of the rotator cuff tendons is an especially painful injury and usually the result of a wearing down of these tendons which occurs slowly over time as a person ages. Rotator cuff tears are more common in the dominant arm. If a person has a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder, even if they have no pain in that shoulder. A torn rotator cuff will weaken a person’s shoulder. This means that many daily activities such as combing one’s hair or getting dressed may become painful and difficult to do.
Several factors contribute to degenerative, or chronic, rotator cuff tears such as repetitive stress, lack of blood supply and bone spurs. Repetitive stress occurs as a result of repeating the same shoulder motions again and again which can stress one’s rotator cuff muscles and tendons. Many jobs and routine chores can cause overuse tears as well. Lack of blood supply naturally happens as a person gets older and can result in the blood supply of the rotator cuff tendons lessening. Without a good blood supply, the body’s natural ability to repair tendon damage is impaired which can ultimately lead to a tendon tear.
Bone spurs (bone overgrowth) can occur as a person ages, often developing on the underside of the bone on top of one’s shoulder. When a person lifts their arms, the spurs rub on the rotator cuff tendon. This condition is called shoulder impingement and, over time, will weaken the tendon and also make it more likely to tear. Rotator cuff tears do not just happen as a result of degeneration. They can also occur when a fall results in a shoulder injury, such as a broken collarbone or dislocated shoulder. Treatments may include surgery, rest, activity modification, medications, exercise, physical therapy (PT) and corticosteroid injections.
Heberden’s and Bouchard’s Nodes. Heberden’s nodes are bony lumps on the finger or toe joints closest to the nail. The bony lumps that form on the middle joint of the fingers or toes are known as Bouchard’s nodes. It is also common to have these bony bumps at the base of the thumb. These bony enlargements typically occur in middle-aged and elderly people with osteoarthritis. When a person first develops them, there is a chronic swelling of the affected joints followed by a painful onset of numbness and redness. When the initial inflammation and pain subsides, the person is left with hard outgrowths on the fingers and toes. Although these outgrowths are generally painless, they may cause the loss of coordination in their hands which may make it difficult to do things such as write and button one’s clothing. Heberden’s nodes are more common in women than in men. The risk factors for Heberden’s and Bouchard’s Nodes seems to be related to genetics. Treatments may include exercise, over the counter pain relievers, arthroscopic lavage and surgery.
Trigger Finger, also called stenosing tenosynovitis, occurs when the sheath surrounding the tendon that helps fingers flex starts to narrow. The narrowing of the flexor tendon’s sheath may cause a person’s affected finger to get stuck in a bent position and when the finger straightens, it snaps like when the trigger of a gun is pulled and released. Trigger finger can be very painful and can result in one not be able to use their fingers which can impact daily activities including eating, dressing and bathing. The trigger effect is usually more pronounced in the morning or while gripping object firmly. Although trigger finger usually only happens to one finger at a time, it can affect several simultaneously. Fingers affected most often are the thumb, middle, ring or index fingers. Severe trigger finger can result in the finger being stuck in the bent position. While the cause of trigger finger is unknown, trigger finger is more common in women than in men. Other risk factors may include:
- those who have recently had surgery for carpal tunnel syndrome
- those who perform repetitive activities, tasks or hobbies with their fingers
Treatment for trigger finger varies depending on the severity, however, some treatments may include over the counter pain medications, corticosteroid injections and surgery.
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