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AN3202 > Placebo/hip > Flashcards

Placebo/hip Flashcards

1
Q

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

A

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

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2
Q

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?

A

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

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3
Q

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?

A

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.

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4
Q

What type of joint is the hip joint?

A

Diarthrodial ball and socket

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5
Q

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

A

Flex/ext
Abd/add
Med/lat rotation

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6
Q

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

A

Lunate surface

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7
Q

What does the transverse acetabular ligament do?

A

Forms the inferior surface of the acetabulum

Connects two ends of the horseshoe-shaped lunate surface

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8
Q

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

A

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

Normal: 22-43 degrees

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9
Q

A decreased central edge angle indicates increased risk of ____________________

A

Superior dislocation

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10
Q

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

A

True

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11
Q

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

A

CT or MRI

18.5deg in M, 21.5deg in F

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12
Q

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

A

Anterior dislocation

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13
Q

What is the femoral neck orientation? (3 directions)

A

Medial, superior, anterior

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14
Q

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

A

angle between neck and shaft of femur

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

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15
Q

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

A

150deg

125deg

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16
Q

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

A

> 135deg: Coxa valga
<120deg: Coxa vara
q\

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17
Q

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

A

Smaller; pelvic width

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18
Q

Explain how coxa valga is associated with:

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

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

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19
Q

What is the MC cause of coxa valga?

A

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

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20
Q

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

A

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

21
Q

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

A

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

22
Q

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

A

Sheppard’s crook
Osteogenesis imperfecta
Pagets
Osteomyelitis

23
Q

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

A

Coxa vara

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

24
Q

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?

A

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

25
Q

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

A

Anteversion

Retroversion

26
Q

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

A

Internally. toe-in

Externally, toe-out

27
Q

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?

A

Anterior and superior

Coxa valga, femoral anteversion, decreased centre edge angle

28
Q

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

A

Pubofemoral ligament: abduction and extension

Iliofemoral (Y) ligament: hyperextension, adduction (superior fibres), abduction (interior fibres)

Ischiofemoral ligament: extension

29
Q

What is the closed pack position of the hip?

A

Position where all ligaments are at their tightest.

Extension, abduction, medial rotation

30
Q

What is the position of maximum congruence of the hip?

A

Frog leg - abduction, flexion, external rotation

31
Q

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

A

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!

32
Q

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

A

Eccentric

33
Q

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

A

Restricted ROM due to passive structures

Knee flexion causes reduced hip extension
Knee extension causes reduced hip flexion

34
Q

What is active insufficiency?

A

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

35
Q

Which hip flexor muscle is affected by active insuffiency? Explain

A

Rec fem

If knee extended and hip flexed, muscle shortens to the point where it can’t generate force

36
Q

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

A

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

37
Q

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

A 
Hip flexion (beginning of stance phase)
Moment arm shortened
38
Q

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

A

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

39
Q

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

A

Increase; decrease

40
Q

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

A

Ante; in

41
Q

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

A

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

42
Q

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

A

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

43
Q

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

A
  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
44
Q

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

A

Internal rotation

45
Q

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?

A
  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
46
Q

What is a 95% confidence interval?

A

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

47
Q

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

A

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

48
Q

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

A

AN3202 (6 decks)

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