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Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).
Types of Musculo-Skeletal disorders in elder(2)
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
7. Low back pain
Osteoarthritis (OA), a form of arthritis, is defined as a condition of as a result of aging causes of wear and tear on a joint, affecting over 25 million people in the United States in alone. University of Porto Medical School indicated that one must understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints(3).
The aim of the treatment is to relieve symptoms of the disease
a. Acetaminophen such as Tylenol can help to relive the pain of Osteoarthritis. In the study to Tramadol/APAP add-on significantly improved knee OA pain which had been inadequately controlled by NSAIDs. Both tramadol/APAP and NSAIDs were effective at maintaining the pain-reduced state(238)(239).
b. According to RX(241) list side effects are not limit to
b.1. Nausea(239) and vomiting(240)
b.2. Appetite loss(241)
b.5. Dark urine(241)
b.6. Abdominal pain(241)
2. Nonsteroidal anti-inflammatory drugs (NSAIDs).
a. The use of the medicine should be taken into account of in cost effectiveness, adverse event data and individual cardiovascular and gastrointestinal risks(242).
b. Side effects are not limit to
According to King’s College School of Medicine and Dentistry, nonsteroidal anti-inflammatory drugs may cause(243)
b.1. A nonspecific colitis (in particular, fenemates), and many patients with collagenous colitis are taking NSAIDs.
b.2. Large intestinal ulcers, bleeding, and perforation
b.3. Relapse of classic inflammatory bowel disease
b.4. Serious complications of diverticular disease (fistula and perforation)
b.5. Small intestinal perforation, ulcers, and strictures requiring surgery
b.6. Specific biochemical and subcellular organelle damage(243).
Narcotics are natural opioid drugs derived from the Asian poppy may provide relief from more severe osteoarthritis pain(245), with additive effect(246).
b. According to NIH, the side effects(247) are not limit to
b.1. Risk of dependence
b.2. Dizziness and drowsiness
b.3. Nausea and vomiting
b.4. Headache and fatigue
b.5. Others include
A.4.. Non medication therapy
1. Physical therapy or physiotherapy
Physical therapy is the form of medical rehabilitation for develop, maintain and restore maximum movement and functional ability for patients caused by injure, aging and other external factors such as diseases(250). In knee osteoarthritis, according to The University of Melbourne, more research may be needed to support the claim, physiotherapy interventions has shown to reduce pain and improve function in those with knee OA(249). But according to the joint study by the University of Melbourne, University of Otago and Monash University, physical therapy dose not result in greater improvement in pain or function than other treatment such as sham treatment in patients with hip osteoarthritis(248).
2. Occupational Therapy
According to the Canadian Association of Occupation Therapists, Occupational therapy is the form of treatment involved evaluating and improving a persons functional abilities of a specific age group or disability such as arthritis, developmental coordination disorder, mental illness, or spinal cord injury, etc...(251). But some research suggested that patient should be encouraged to change of lifestyle to achieve a optimal self-managing the effects and symptoms of OA(252).
Unfortunately, according to the University of Alberta, the implication for Rehabilitation Pain gasp has not been focused in training programs in occupational therapy education even it is a prevalent condition in all age groups(253). Some research in regarded to occupation therapy in treatment of hand exercise in osteoarthritis, insisted that high-quality studies are necessary to establish a strong and sound of evidences in concerning functional assessment and the effect of hand exercises in hand osteoarthritis(254).
In need, depending to the individual needs, including patients education and self-management programs. Weight loss may be necessary if the osteoarthritic patient is overweight(255); physical therapy may also be needed for muscle strengthening with aerobic conditioning(256)(257) and tai chi exercise(258) with improving pain and function in people with OA, depending to the disease severities(258), etc.
Surgery only necessary if symptoms persist, depending on several factors, including the location and severity of OA damage, patient characteristics and risk factors.(265).
1. Arthrocentesis plus corticosteroid
Arthrocentesis is a medical procedure to remove joint fluid with a sterile needle for analysis through injection of corticosteroids into the joints to relieve pain, swelling, and inflammation. According to Regions Hospital, there is a reluctance of surgeon to perform such operation in patient who are receiving anticoagulation at therapeutic levels(263).
According to the Mayo clinic, cortisone shots overdoses can cause joint damage(264).
Arthroscopy is a minimally invasive surgical procedure to examine and treat the abnormalities of and damage to the cartilage and ligaments through the arthroscope. It is considered as one of the standard interventions with low potential for complications for patient with knee osteoarthritis(265) and ankles, shoulders, elbows, wrists and hips osteoarthritis(266).
3. Lubrication injections
Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) are recommended only to patients who have not found adequate pain relief in conservative treatment(268).
Platelet-rich plasma (PRP) contains high concentrations of autologous growth factors that originate from platelets influences the production of SZP from human joint-derived cells, has shown effectively in treatment of osteoarthritis or damage in the knee joint. or damage in the knee joint, according to the study by University of California(267).
4. Realigning bones
Osteotomy is a surgical procedure used to realign bones, cartilage and reposition the joint to reduce knee pain by shifting your body weight away from the damaged cartilage(269). Osteotomies about the hip may be used for the prevention and treatment of osteoarthrosis(270), only if the mechanical causes of the potential or established osteoarthritis is clear and the operation succeeds in reducing the pathologically excessive joint loads(271).
5. Joint replacement
Joint replacement is a surgical procedure of orthopedic surgery to relief pain and to place the damaged joint surfaces(272). Over 1 million surgical procedure have been perform in elective total knee and hip replacements annually in the United States alone(273). According to study, over 70 % of patients who received rapid mobilization of total joint replacement patients recover safely and reduced the overall length of hospital stay(274).
Joint replacement is considered as a treatment only for patients with severe joint pain or dysfunction that can not be alleviated by non invasive treatments. But, according to Odense University Hospital, hip replacement can be postponed in patients with severe hip osteoarthritis if patients participate in a education and supervised exercise program(275).
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(1) Prevalence of rheumatic symptoms, rheumatoid arthritis, ankylosing spondylitis, and gout in Shanghai, China: a COPCORD study by Dai SM1, Han XH, Zhao DB, Shi YQ, Liu Y, Meng JM.(PubMed)
(2) Musculoskeletal Disorders in the Elderly by Ramon Gheno, Juan M. Cepparo, Cristina E. Rosca,1 and Anne Cotten(PMC)
(3) The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review by Pereira D1, Peleteiro B, Araújo J, Branco J, Santos RA, Ramos E.(PubMed)
(4) Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis by Waller B1, Ogonowska-Slodownik A2, Vitor M3, Lambeck J4, Daly D5, Kujala UM6, Heinonen A7.(PubMed)
(5) Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with kneeosteoarthritis: A systematic review and meta-analysis by Zhang C1, Xie Y2, Luo X3, Ji Q3, Lu C3, He C4, Wang P3.(PubMed)
(6) Oral intake of purple passion fruit peel extract reduces pain and stiffness and improves physical function in adult patients with knee osteoarthritis by Farid R1, Rezaieyazdi Z, Mirfeizi Z, Hatef MR, Mirheidari M, Mansouri H, Esmaelli H, Bentley G, Lu Y, Foo Y, Watson RR.(PubMed)
(7) Functional ability, mobility, and pain before and after knee replacement in patients aged 75 and older: a cross-sectional study by Limnell K1, Jämsen E, Huhtala H, Jäntti P, Puolakka T, Jylhä M.(PubMed)
(249) Physiotherapy management of knee osteoarthritis by Page CJ1, Hinman RS, Bennell KL.(PubMed)
(250) Policy statement: Description of physical therapy(World federation of physical therapy)
(251) Occupational Therapy - As defined by the Canadian Association of Occupational Therapists(Canadian Association of Occupation Therapists)
(252) Integrating lifestyle approaches into osteoarthritis care by Garver MJ1, Focht BC2, Taylor SJ3.(PubMed)
(253) Occupational therapists' pain knowledge: a national survey by Reyes AN1, Brown CA1.(PubMed)
(254) Occupational therapy-based and evidence-supported recommendations for assessment and exercises in handosteoarthritis by Kjeken I1(PubMed)
(255) Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review by H Bliddal,1 A R Leeds,2,3,4 and R Christensen1(PubMed)
(256) Strength cycle training: effects on muscular strength and aerobic conditioning. by Van Zant RS1, Bouillon LE.(PubMed)
(257) Effect of resistance training and aerobic conditioning on muscular strength and submaximal fitness for individuals with chronic heart failure: influence of age and gender. by Swank AM1, Funk DC, Manire JT, Allard AL, Denny DM.(PubMed)
(258) A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. by Bennell KL1, Hinman RS.(PubMed)
(259) Osteoarthritis(Medline Plus)
(260) Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. by Jansen MJ1, Viechtbauer W, Lenssen AF, Hendriks EJ, de Bie RA.(PubMed)
(261) Manual therapy for osteoarthritis of the hip or knee: a systematic review by Review published: 2011.Bibliographic details: French HP, Brennan A, White B, Cusack T. Manual therapy for osteoarthritis of the hip or knee: a systematic review. Manual Therapy 2011; 16(2): 109-117. [PubMed]
(263) Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels by Ahmed I1, Gertner E.(PubMed)
(264) Tests and Procedures, Cortisone shots(Mayo Clinic)
(265) [Complications of knee arthroscopy].[Article in German] by Mayr HO1, Stoehr A2.(PubMed)
(266) Arthroscopy(NHS choice)
(267) Stimulation of the superficial zone protein and lubrication in the articular cartilage by human platelet-rich plasma by Sakata R1, McNary SM1, Miyatake K1, Lee CA1, Van den Bogaerde JM1, Marder RA1, Reddi AH2.(PubMed)
(268) Non-surgical treatment of osteoarthritis-related pain in the elderl by Saulat Mushtaq,3 Rabeea Choudhary,2 and Carla R. Scanzello(PMC)
(269) Knee Osteotomy(The Knee Society)
(270) Osteotomies about the hip for the prevention and treatment of osteoarthrosis by Millis MB1, Murphy SB, Poss R.(PubMed)
(271) Osteotomies of the hip in the prevention and treatment of osteoarthritis by Millis MB, Poss R, Murphy SB.(PubMed)
(273) Parachutes and Preferences - A Trial of Knee Replacement by Katz JN1.(PubMed)
(274) Rapid mobilization decreases length-of-stay in joint replacement patients by Tayrose G, Newman D, Slover J, Jaffe F, Hunter T, Bosco J 3rd.(PubMed)