Upper extremity motor dysfunction in aging
Susceptible groups and risk factors
1. Common upper extremity musculoskeletal diseases
Joint function refers to joint flexion and extension, rotation, adduction and abduction, and joint dysfunction refers to the inability to complete the above-mentioned normal joint range of motion. Joint dysfunction of the elderly at home usually manifests as joint movement disorders, soreness, weakness and other symptoms, which are more common in shoulder joints, knee joints, hip joints and spine. The causes of upper limb joint dysfunction include: upper limb joint flexibility dysfunction, motor sensory dysfunction caused by peripheral nerve injury, soft tissue extensibility dysfunction around the upper limb joint, and stability and motor control dysfunction.
Langer’s axillary arch (a fleshy slump extending from the latissimus dorsi to the anterior humerus, the origin of which is still debated) is a variant of the anatomical structure in the underarm. The incidence rate is 43.8%, usually bilateral, occasionally only unilateral. In recent years, researchers have continuously pointed out that Langer's axillary arch is related to the effect of breast cancer surgery and the occurrence of other diseases. Its existence will increase the difficulty of sentinel lymph node biopsy, affect breast cancer level I axillary lymph node dissection, and may also compress the axillary vein, causing thoracic outlet syndrome and so on.
The clinical consequences of pectoralis minor variations are usually mild, but they can also lead to thoracic outlet syndrome, subcoracoid or subacromial impingement, adhesive capsulitis, dyskinesia, and even SLAP (upper lip anterior to posterior) lesions. Anatomical variations in the coracobrachialis, flexor hallucis longus, and pronator teres may involve musculocutaneous and median neuropathy.
The glenohumeral joint is the most distal movable limb in the shoulder compound joint. Because of its loose joint capsule and relatively flat and small articular surface, it is highly mobile. These features that make the glenohumeral joint have a large range of motion also make it prone to instability, especially when repeated activities that are large and close to the end of the joint range of motion, it is more likely to cause excessive laxity and dislocation of the glenohumeral joint in the elderly or subluxation (often referred to as shoulder instability) clinical condition. In addition to being prone to instability, the glenohumeral joint is also often affected by degeneration-related pathology. A common cause of many pathologies is that the connective tissue surrounding the joint and the adjacent rotator muscles are under excessive stress, the compressed and injured tissue often becomes inflamed and painful, and a subacromial bursa may develop arthritis, rotator tendonitis, and adhesive arthritis. Subacromial pinch syndrome is the most common shoulder pain, and its pathological mechanism is mainly caused by repeated abnormal compression of the tissues in the subacromial space, that is, the supraspinatus tendon, the long head of the biceps tendon, the upper The joint capsule, as well as the subacromial bursa, is compressed between the humeral head and the coracoid acromial arch. The pain caused by subacromial pinch is usually concentrated in the front of the shoulder, and the pain will be exacerbated by active abduction of 60°~120°. Raising the arms above the head is important in activities of daily living, and subacromial pinch syndrome can cause significant functional limitations. This condition is most common in athletes and laborers who repeatedly abduct the shoulder beyond 90°, but can also occur in older adults who are statically active.
In addition, proximal humeral fractures mostly occur in elderly patients, and a considerable number of patients have varying degrees of rotator cuff injury before trauma. Some foreign scholars have found through ultrasound and MRI examinations that 26.2% to 49.4% of the examinees have rotator cuff injuries of varying degrees. The incidence and severity of rotator cuff injuries increase with age. Therefore, even if the rotator cuff of elderly patients is intact at the time of injury, considering its natural outcome, as the patient ages further, there may be a sudden decline in shoulder joint function in the late stage, which is related to the gradual new loss of the rotator cuff.
2. Common upper extremity nerve injuries
In recent years, due to the influence of various factors, the number of upper limb nerve injuries in the human body is increasing day by day. The more common upper limb nerve injuries mainly include brachial plexus injury, radial nerve injury, musculocutaneous nerve injury, ulnar nerve injury, axillary nerve injury and Median nerve injury, etc. A large number of clinical treatment cases have shown that patients with upper limb nerve injuries cannot receive timely treatment or misdiagnosed by the hospital, which leads to delays in the best time for treatment, and even leads to disability of patients, which seriously affects physical and mental health and prevents patients from performing normal tasks. work and social activities.
Full-cycle management of upper limb movement disorders in the elderly
As a special group, the elderly are mostly accompanied by multi-system dysfunction and coexistence of multiple diseases. They can be managed with a full-cycle rehabilitation model. The full-cycle rehabilitation of the elderly includes the full cycle of disease, the full cycle of dysfunction, the full cycle of hierarchical diagnosis and treatment, the full cycle of participants, and the full cycle between different regions. Requirements for the rehabilitation of upper limb motor function in the whole cycle of the elderly: tertiary diagnosis and treatment institutions and the three-level structure of hospital rehabilitation-community rehabilitation-family rehabilitation rely on information platform for information sharing and management. Targeted treatment for different degrees of severity. The general management process principles are as follows:
① Preventive treatment
For the high-risk elderly population with risk factors, drug treatment guidance and lifestyle intervention are required to change unhealthy lifestyles, actively control risk factors, try to avoid the occurrence of diseases, and provide relevant knowledge education to high-risk groups and their families. Use the information platform to do follow-up registration, screening, management, and intervention in the three-level rehabilitation system, especially in the community.
② Early treatment
For patients who have developed the disease but have not yet caused upper limb motor dysfunction, rehabilitation interventions are effectively carried out during the full-cycle rehabilitation process in the hospital, such as good limb positioning, isometric exercise and other rehabilitation practices, to actively alleviate motor dysfunction. When carrying out rehabilitation treatment, transfer training, bridge exercise, etc. should be carried out according to the motor function of the patient. And educate patients and their families about disease rehabilitation and nursing knowledge.
③ Recovery period treatment
Fully assess the existing functional impairment, carry out staged and individualized rehabilitation treatment, and provide patients with home rehabilitation programs to improve the quality of life of patients. During the period of out-of-hospital rehabilitation, the information platform is used to connect the rehabilitation of hospitals and community families, and provide good guidance and services for home rehabilitation.
