Some diseases are common with age. Symptoms tend to appear gradually and intermittently, allowing many people to adapt to these changes without seeking medical advice. One example is presbyopia. Most of us figure out that we need reading glasses and manage this without a clinician’s advice. Another example is most of the bodily aches and pains from arthritis, old injuries, and tendinopathies associated with age: most are managed without seeking care. 

Do clinicians factor this into their care and advice for people that do seek medical expertise? Hand surgeons often discuss management of trapeziometacarpal arthrosis as if everyone with the disease presents for treatment. Evidence suggests that trapeziometacarpal arthrosis is a universal aspect of human aging (1, 2). It seems safe to assume that most people never seek medical attention (1). When we studied factors independently associated with having pain or limitations related to TMC arthrosis among people not seeking care for that condition, we confirmed that the disease is prevalent, often with few symptoms, and found no factors associated with worse disease or worse symptoms (3). 

Age-related disorders are often misperceived as an acute injury. The prevalence of rotator cuff abnormalities in asymptomatic people is high enough for degeneration of the rotator cuff to be considered a common aspect of normal human aging (4). When we studied people with new symptoms in their shoulder or knee after a single event at work, the opposite, asymptomatic knee or shoulder had equal or worse pathology (5).     

Our research on the misinterpretation of symptom onset as disease onset is focusing on several areas:

1. We are defining the age and gender-related prevalence of common diseases.
2. We are investigating treatments that optimize adaptation in patients who present with symptoms and limitations related to expected changes in the body. 
3. We are studying the factors associated with measurable severity of age-related changes (3). 

References:

1. Becker SJ, Briet JP, Hageman MG, Ring D. Death, taxes, and trapeziometacarpal arthrosis. Clin Orthop Relat Res. 2013 Dec;471(12):3738-44. PubMed PMID: 23959907; PubMed Central PMCID: PMC3825869.
2. Sodha S, Ring D, Zurakowski D, Jupiter JB. Prevalence of osteoarthrosis of the trapeziometacarpal joint. J Bone Joint Surg Am. 2005;87(12):2614-8.
3. Wilkens SC, Tarabochia MA, Ring D, Chen NC. Factors Associated With Radiographic Trapeziometacarpal Arthrosis in Patients Not Seeking Care for This Condition. Hand (N Y). 2017 Sep 1:1558944717732064. doi:10.1177/1558944717732064. [Epub ahead of print] PubMed PMID: 28918660.
4. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec; 23(12):1913-1921. doi: 10.1016/j.jse.2014.08.001. Review. PubMed PMID: 25441568.5. 
5. Liu TC, Leung N, Edwards L, Ring D, Bernacki E, Tonn MD. Patients Older Than 40 Years With Unilateral Occupational Claims for New Shoulder and Knee Symptoms Have Bilateral MRI Changes. Clin Orthop Relat Res. 2017 Jun 9. doi:10.1007/s11999-017-5401-y. [Epub ahead of print] PubMed PMID: 28600690.