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Systemic Diseases affecting TS (polymyalgia rheumatica (giant cell…
Systemic Diseases affecting TS
Ehlers Danlos
Inherited
Defect in collagen metabolism
kyphoscoliotic type (VI)
Onset in infancy
rapid progression
dislocations common
surgical intervention if needed
NWB exercises
Avoid sports that strain joints
clinical features
sacroilitis, enthesitis, uvitis
Ankylosing spondylitis
inflammatory back pain and ankylosis
onset: teens or early adult (<40 y.o.)
men>women
risk factors
physical trauma
intense physical training
heavy work
types
juvenile onset
enthesopies
arthritis
adult onset
Symptoms
stiffness, bilateral SIJ and spinal pain
in the morning, after rest periods, with activity and bending
Treatment
Exercise
stretching and resistance training
aerobic training
breathing exercise
polymyalgia rheumatica
inflammatory disorder: unknown origin
onset: older adults
stiffness and muscle pain in morning or after activity
no weakness
inc ESR, anemia, fever, fatigue, lethargy, anorexia, WL
(-) for rheumatoid and inflammatory arthritis
Resolves 1-2 years
affects b/l shoulders, ihps and neck
giant cell arteritis often overlaps and occurs with PMR
can lead to blindness
Scheuermann's disease
vertebral osteochondrosis
dx by radiographs
thoracic kyphosis >45 deg
at least one vertebrae wedged min of 5 deg
prevalence
men:4%
women: 2%
genetic component
clinical presentation
mild pain near apex of deformity
pain ceases at end of growth period
sternum typically smaller in length
prognosis and progression of kyphosis unknown
structural causes
growth disturbance
epiphyseal vertebral endplate degeneration
wedge vertebrae or IVD space narrowing
Treatment
PT
inconclusive in skeletally immature
helpful for adults
bracing
helpful and more effective than PT if early diagnosis prior to curve >50 deg in those still growing
extension sports and hyperextension exercise
Osteoporosis
osteoporosis: -2.5 SD, osteopenia: -1-2.5 SD
incidence increases post menopause
may result in fracture
Frax tool
flexion exercises increase fracture risk
compressive and shear train occur largely in thoracic spine
cochrane review: improvement in femur and spine, no effect on fracture risk
BMD
high BMD may lower future fracture risk
high impact and resistance training increase BMD