MEET MARY

Mary’s Story

• Born 1948 – small rural town in northern Ontario
• Grade 8 education
• Worked at the local general store
• Met and married Jack
• Had two children, Phillip and Nancy

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Mary’s Story Continues

• Matrimonial home
• Stay-at-home mother
• Raised her children
• Loved to garden
• Attended church regularly
• Entertained her friends from church

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Mary’s Symptoms

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handarmdoc

Mary’s Diagnosis

• 2012-diagnosed with Stage 4 osteoarthritis (OA) and osteoporosis(OP)

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Diagnosis

• Physical examination checks affected joints for tenderness, swelling, redness,

and flexibility

Imagining tests

• X-ray
• Magnetic resonance imaging
• Bone densitometry

Lab tests

• Blood tests
• Joint fluid analysis

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Osteoarthritis Overview

• Called degenerative joint disease
• Most common form of arthritis
• Affecting millions of people worldwide
• Occurs when the protective cartilage that cushions the ends of the bones wears down over time
• Can damage any joint
• Most commonly affects joints in hands, knees, hips & spine
• OA can cause pain, stiffness & swelling
• Can cause reduced function & disability

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4 Stages of Osteoarthritis

Stage 1 – Minor

• Very minor wear & tear and bone spurs, unlikely to feel pain or discomfort
• Treatment-supplements (glucosamine & chondroitin), regular exercise

Stage 2 – Mild

• Noticeable bone spurs on x-ray, stiffness and discomfort
• Treatment-OTC pain medications, stricter exercise routine

Stage 3 – Moderate

• Cartilage is affected, narrow gap between bone and joint
• Joint becomes inflamed, discomfort with ADLs
• OTC pain medication or prescription pain medications, hyaluronic injections

Stage 4 – Severe

• Cartilage is almost completely gone, bone spurs have multiplied, very painful
• Inflammatory response from the joint
• OTC pain medication or prescription pain medications, hyaluronic injections
• Bone realignment surgery for knee & hip

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X-rays

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Osteoarthritic Hip & Spine

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Stepped-Care Approach for the Treatment of OA

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OA cannot be reversed

treatments can reduce pain

& improve movement

Medications Commonly Used for OA

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Doctor4U_UK

OTC medications aren’t working….

• Opioids-low dosages and careful monitoring
• May cause chronic constipation
• Older patients at risk of falls

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• Intra-articular injections of corticosteroids

or hyaluronic acid

• Short-term relief lasting 4 to 8 weeks
• May cause flare-up within the first 24 hours
• Improvement from baseline at 48 hours

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Number of accidental apparent opioid-related deaths by province and territory. January 1, 2016 to September 30, 2017.

Mary’s Symptoms

Typically there are no symptoms in the early stages

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Mary thought….

The back pain was part of growing old,

along with the being a ‘bit shorter’

& the slight stoop in her posture

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Osteoporosis Overview

• Causes bones to become weak & brittle
• A fall or even mild stress can cause a fracture
• OP related fractures most commonly occur in the hip, wrist, or spin
• Bone is living tissue that is constantly being broken down & replaced
• OP occurs when the creation of new bone doesn’t keep up with the loss of old bone
• OP affect men & women of all races
• White & Asian women (especially post-menopause) are at higher risk

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https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968

Causes of OP

• After the early 20s the process of making new bone slows
• Most people reach their peak bone mass by age 30
• How likely you are to develop OP depends partly on how much bone mass you attained in your youth
• Peak bone mass is somewhat inherited and also varies by ethnic group

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Intramembranous Ossification

 Intramembranous ossification follows four steps.

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1. Mesenchymal cells group into clusters, and ossification centers form.
2. Secreted osteoid traps osteoblasts, which then become osteocytes.
3. Trabecular matrix and periosteum form.
4. Compact bone develops superficial to the trabecular bone, and crowded blood vessels condense into red marrow.

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Endochondral Ossification

Endochondral ossification follows six steps.

1. Mesenchymal cells differentiate into chondrocytes.
2. The cartilage model of the future bony skeleton and the perichondrium form.
3. Capillaries penetrate cartilage. Perichondrium transforms into periosteum. Periosteal collar develops. Primary ossification center develops.
4. Cartilage and chondrocytes continue to grow at ends of the bone.
5. Secondary ossification centers develop.
6. Cartilage remains at epiphyseal (growth) plate and at joint surface as articular cartilage.

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Risk Factors

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Complications

Bone fractures:

• Particularly in the spine or hip
• Often caused by a fall & can result in disability
• Increase risk of death within the first year after injury
• Spinal fractures can occur without injury
• Vertebrae can weaken to the point of crumpling

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Prevention

• Good nutrition
• Body weight
• Calcium
• Vitamin D
• Exercise
• Limit alcohol consumption
• Quit smoking

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Mary’s Fall

Symptoms:

• Inability to get up from a fall or to walk
• Severe pain in hip or groin
• Inability to weight bear on the affected side
• Bruising & swelling in & around hip area
• Shorter leg on the affected side
• Outward rotation of the leg on the affected side

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https://fineartamerica.com/featured/1-elderly-woman-injured-by-falling-paul-rapsonscience-photo-library.html

Surgical Repair

The type of repair depends on where & how severe

the fracture is, displaced bone, age, & underlying

health conditions.

Options include:

• Internal repair using screws
• Total hip replacement
• Partial hip replacement

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Rehabilitation

Out of bed and moving on the 1^st day post-op

Physical therapy will initially focus on ROM and strengthening exercises

Home exercise program and follow-up PT appointments

Assistive devices required: walker, cane, safety bars in bathtub, elevated toilet seat

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Precautions to prevent a dislocation

Posterior Approach:

• Do not bend at the waist past 90 degrees
• Do not cross your legs
• Do not internally rotate the surgical leg

Anterior Approach:

• Do not step backwards with the surgical leg
• Do not externally rotate the surgical let

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Complications

• Can reduce independence
• About half the people who have a hip fracture do not

regain the ability to live independently

Immobility may lead to:

• Blood clots in the legs or lungs
• Bedsores
• Urinary tract infections
• Pneumonia
• Further loss of muscle mass
• Increase risk of falls & injury
• Death

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Post-Operative Depression

It can be challenging to differentiate between typical post-op recovery and depression symptoms.

Depression is a psychological illness that can lead to impaired decision-making, difficulty with day-to-day life, and may lead to physical illness.

Signs & Symptoms of Depression:

• Eating significantly more or less than is normal
• Sleeping significantly more or less than is normal
• Fatigue
• Irritability
• Difficulty making decisions, even minor ones
• Loss of interest in activities
• Feelings of hopelessness and despair
• Feelings of anxiety, stress, agitation or restlessness
• Thoughts of self-harm
• Thoughts of harming others

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Student Survey

https://docs.google.com/forms/d/1Z0mA72XgmNmnBjfL80KvZqocPp_lD_mu4OSoLVR4VeU/edit

Instructor Survey

https://docs.google.com/forms/d/1PuFqVc78An82mbj_0NIfMdB3Nh-2_3x5JMNWqWj52Iw/edit

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