Placebo/hip

Question 1

What was the finding of Gracely et al (1985) in the effect of patient and practitioner expectation wrt placebo?

Answer 1

Clinical analgesia depends not only on physiological action of the treatment administered but also on the expectations of the patient and clinician

Question 2

Buske-Kirschbaum et al (1992) were able to increase NK cell activity after exposing rats to sherbet. How did they do it? What important conclusion did they draw?

Answer 2

Classical conditioning - repeatedly paired sherpet with subcut injection of epinephrine. Eventually tried with saline instead of epinephrine and same increase in NK cells was seen

Conclusion: placebo can modify the immune response

Question 3

Kalauokalani et al (2001) studied the impact of patient expectation on outcomes of treatment with acupuncture and massage. What did they find? What implications does this have on clinical research?

Answer 3

If you got the treatment you thought would be better for you, you did better than if you got the treatment you didn’t think would be better for you.

Implications: method of recruitment (eg. from surgeons vs chiro office) could have large effects on patient outcomes.

Question 4

What type of joint is the hip joint?

Answer 4

Diarthrodial ball and socket

Question 5

What are the 3 degrees of freedom of the hip joint?

Answer 5

Flex/ext
Abd/add
Med/lat rotation

Question 6

Name for the portion of the acetabulum which is covered by hyaline cartilage

Answer 6

Lunate surface

Question 7

What does the transverse acetabular ligament do?

Answer 7

Forms the inferior surface of the acetabulum

Connects two ends of the horseshoe-shaped lunate surface

Question 8

What is the central edge angle/angle of Wiberg? What is a normal range?

Answer 8

A line connecting the lateral rim of the acetabulum and the centre of the femoral head

Normal: 22-43 degrees

Question 9

A decreased central edge angle indicates increased risk of ____________________

Answer 9

Superior dislocation

Question 10

True or false: CE increases with age, so kids’ hips are less stable

Answer 10

True

Question 11

Which imaging modality can be used to assess acetabular anteversion? What is a normal measurement?

Answer 11

CT or MRI

18.5deg in M, 21.5deg in F

Question 12

pathological increase in the acetabular anteversion angle can result in increased risk of ____________________

Answer 12

Anterior dislocation

Question 13

What is the femoral neck orientation? (3 directions)

Answer 13

Medial, superior, anterior

Question 14

What is the angle of inclination? What is its purpose?

Answer 14

angle between neck and shaft of femur

Causes the greater trochanter to lie at the ntre of the femoral head

Question 15

What is a normal angle of inclination in babies? In adults?

Answer 15

150deg

125deg

Question 16

What is the name for a pathological increase in the angle of inclination? Pathological decrease?

Answer 16

> 135deg: Coxa valga
<120deg: Coxa vara
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Question 17

The angle of inclination is somewhat ___________ in women due to the increased ________________

Answer 17

Smaller; pelvic width

Question 18

Explain how coxa valga is associated with:

• knee OA
• hip OA
• osteoporosis of the femoral neck
• hip joint dislocation

Answer 18

Knee OA: causes genu varum, increasing compression on medial aspect of knee

Hip OA: more stress at superior/medial aspect of femoral head

Osteoporosis of the femoral neck: decreased tension forces going through neck of the femur

Question 19

What is the MC cause of coxa valga?

Answer 19

Neuromuscular disorders (cerebral palsy, polio), skeletal dysplasia, JIA

Question 20

In individuals with coxa valga, which muscle group needs to work much harder? Why?

Answer 20

Abductors - moment arm between head of femur and trochanter is much shorter

Question 21

What compensation is commonly seen in the gait of individuals with coxa valga? Why?

Answer 21

Lateral trunk bending towards stance leg. Helps decrease the moment arm of the trunk, decreasing the overall amount of the force needed to be opposed by the hip adductors

Question 22

An angle of inclinationof less than 90 degrees is known as a _______________ deformity and is associated with _______________ __________________, ________________, and _________________

Answer 22

Sheppard’s crook
Osteogenesis imperfecta
Pagets
Osteomyelitis

Question 23

Which hip deformity increases the risk of developing SCFE? Why?

Answer 23

Coxa vara

Increased bending moment of femoral neck places shear forces through epihpyseal plate

Question 24

What is the name for the angle between the axis of the femoral neck and axis of the femoral condyles? What is considered normal in newborns? In adults?

Answer 24

Angle of torsion
40deg in newboarns
8-30deg in adults

Question 25

A pathological increased in the angle of torsion is called _____________, where a decrease is called ______________

Answer 25

Anteversion | Retroversion

Question 26

In order for the femoral head to find congruence, the tibia rotates _____________ in anteversion, causing a ______________ gait and ___________ in retroversion, causing a _____________ gait

Answer 26

Internally. toe-in | Externally, toe-out

Question 27

In a neutral standing position, which aspect of the femoral head is exposed? Which 3 deformities can cause more of the femoral head to be exposed?

Answer 27

Anterior and superior | Coxa valga, femoral anteversion, decreased centre edge angle

Question 28

What are the 3 main ligaments of the hip joint? Which motions do they each oppose?

Answer 28

Pubofemoral ligament: abduction and extension Iliofemoral (Y) ligament: hyperextension, adduction (superior fibres), abduction (interior fibres) Ischiofemoral ligament: extension

Question 29

What is the closed pack position of the hip?

Answer 29

Position where all ligaments are at their tightest. Extension, abduction, medial rotation

Question 30

What is the position of maximum congruence of the hip?

Answer 30

Frog leg - abduction, flexion, external rotation

Question 31

True or false: the position of maximum congruence in the hip is also the position of maximum stability

Answer 31

False: max congruence is abd + flex + ext rot, max stability is abd + ext + int rot This is probably the only joint in the body where they are different!

Question 32

Moment generation by the hip muscles is best with (eccentric/isometric/concentric) contractions

Answer 32

Eccentric

Question 33

What is passive insufficiency? How does this affect the hip joint?

Answer 33

Restricted ROM due to passive structures Knee flexion causes reduced hip extension Knee extension causes reduced hip flexion

Question 34

What is active insufficiency?

Answer 34

Restricted muscle power due to the position of the joint causing muscle shortening. Caused by too much overlap in actin-myosin

Question 35

Which hip flexor muscle is affected by active insuffiency? Explain

Answer 35

Rec fem | If knee extended and hip flexed, muscle shortens to the point where it can't generate force

Question 36

Sartorius, like rec fem, crosses both the hip and knee joints. Why is it not affected by active insufficiency?

Answer 36

Very long so position of knee has a very small effect on the proportional length change

Question 37

In which position does glut max have the least ability to generate force?

Answer 37

``` Hip flexion (beginning of stance phase) Moment arm shortened ```

Question 38

What are the 2 major abductors of the hip? Which 2 muscles assist them?

Answer 38

Major: Glut med + min Minor: Sup. fibres of glut max + TFLq

Question 39

Anteversion will cause a(n) (increase/decrease) in internal rotation and a(n) (increase/decrease) in external rotation of the hip

Answer 39

Increase; decrease

Question 40

Children general start out (ante/retroverted) which is why they usually toe-(in/out)

Answer 40

Ante; in

Question 41

Weakness of which muscle will predispose elderly individuals to femoral neck fractures? Why?

Answer 41

Glut med Without glut med, body weight will bend the neck of the femur, placing tension on the superior side of the femoral neck Glut med neutralizes this tension by compressing the superior fem neck

Question 42

In order to bend so that your trunk is perpendicular to the floor, your hip joint needs to bend to <90deg. Why?

Answer 42

To shift COM further backwards, allowing COM to shift over base of support

Question 43

How do the hip joints compensate for leg length changes during walking gait?

Answer 43

1. Swing leg drops to reduce elevation of COM - Stance hip adducts and swing limb abducts to keep femurs perpendicular to ground 2. Stance hip internally rotates while swing hip externally rotates to keep toes pointing forward

Question 44

According to Avman et al (2019) a decrease in which hip range of motion was most strongly associated with NSLBP?

Answer 44

Internal rotation

Question 45

According to Flynn & Fritz (2002), which 5 factors impact the likelihood of successful resolution of LBP from SMT? How many factors are needed for 95% success?

Answer 45

1. Segmental hypomobility/pain upon spinging palpation over lumbar facets 2. Acute onset of pain <16d 3. No pain distal to knee 4. At least 1 hip internal rotation >35deg 5. Low fear avoidance beliefs score

Question 46

What is a 95% confidence interval?

Answer 46

an interval that one is 95% confident includes the population mean (eg. 0.25 - 0.75)

Question 47

If the confidence interval is 0.25 - 0.75, what does this mean about satistical significance?

Answer 47

Result is statistically significant because the interval has a lower limit above 0

Question 48

Movement between 2 objects can be categorized into which 3 groups? Which 2 are seen in the knee joint?