Module 9 Exam Flashcards
(58 cards)
Gracely et al. (1985) - clinical expectations & placebo analgesia in dental patients
Pt were told: narcotic analgesic = decrease pain, saline = no effect, narcotic antagonist = increase pain
PN group = Docs thought subjects either got placebo or naloxone (antagonist)
PNF group = Doc thought subjects either got placebo, analgesic or naloxone
Everyone got placebo in the study. What was the result/conclusion of this study?
Pt did better if their clinician BELIEVED they got the analgesic. Therefore, pt’s perception also plays into how they feel in addition to the physiology
Buske-Kirschbaum (1992) - conditioned increase of NK cell activity
Sweet sherbet + EPI
Sweet sherbet + saline
Control
What was the result/conclusion of this study?
both EPI and saline solution increased NK cell activity. PLACEBO can modify the immune response.
Dr. Kirkaldy-Willis: “any HCP who doesn’t play the placebo to the max, is a fool”
OK
Kalauokalani et al. (2001)
135 pt with chronic LBP receive acu or RMT. Beforehand, patients were asked about their expectations.
What was the result/conclusion of this study?
Pt expectation = clinical outcome. People with positive outlooks were 5x more likely to have substantial improvements
Center edge (CE) angle of the acetabulum
AKA?
Normal range of __-__ deg
Decreased CE?
Angle of Wiberg
22-42 deg
Normal position: LAT with INF and ANT ROT
Decreased CE = risk of superior dislocation (more roof, more stability)
Acetabular anteversion
___ deg in men
___ deg in women
Increased AA?
- 5 M
- 5 W
risk of anterior dislocation
Normal femoral neck orientation
medial, anterior, superior
Angle of inclination
Does it increase or decrease with age?
___ deg babies
___ deg adults
___ deg elders
frontal plane between axis of the femoral neck and the axis of femoral shaft
decreases
150
125 - slightly smaller in women (due to pelvis)
120
DUE TO WB-ing AND GRAVITY! +osteopenia, glute forces, growth plate closures
Angle of inclination - Pathological variance:
- Coxa Vera
- Coxa Valga
Deg?
Consequences?
Causes?
Valga = 135+ deg
- results to weak ABD muscles
- persistence of normal neonatal alignment
- polio, NM disorders, CP, juvenile idiopathic arthritis
- spastic hip FL may be associated with lateral subluxation
Vara = <120 deg
- results in leg to be shortened
- due to Fx/injury, bone softening disorders (osteomalacia, Paget’s)
- Shepards Crook Deformity (<90 deg)
-
Ankle of Torsion
__ deg in newborns
__ -__ deg in adults or average of ___ deg
Increase torsion = anteversion = Toe ___ (common cause?)
Decrease torsion = retroversion = Toe ___ (common cause?)
40 deg
8-30 deg, avg = 15 deg
IN - pt commonly trip as a result of being pigeon toed. Cerebral palsy
OUT - SCFE, common in obese children (or just people in general…)
Frog Leg is the _____ physiological position
Commonly used in what to enhance congruence?
true
hip immobilization - increased joint congruence (ie. in congenital hip dysplasia)
ILF - Iliofemoral (Y ligament of Bigelow) - taut during…
PF - Pubofemoral - taut during…
ISF - Ischiofemoral - taut during…
ILF - Iliofemoral (Y ligament of Bigelow) - taut during…HIP HYPER-EX
PF - Pubofemoral - taut during… HIP ABD+EX
ISF - Ischiofemoral - taut during… HIP EX (unwound in FL)
HIP EX causes the Big 3 Ligaments to be taut hence this is the ________ position
+ 2 other ROM
closed-pack
EX + ABD + IN ROT (think of setting up for a tarsal adjustment?)
Difference between closed-pack and true physio position….
Unlike other joints, the hip’s closed-pack position is NOT the position of highest congruence….Frog Leg (true physio) is.
Ex: MVA - dashboard knee - you can still posteriorly dislocate the femur in this true physio position
Hip: closed pack position (EX+ABD+MED ROT)….is more stable than true physiological position (frog leg)
Pelvis acetabular highway systems (2 main)
Path and what it is the result of….
medial = transmits VERTICAL WB force (COMPRESSIVE)
-originates from the medial cortex of the superior aspect of the femoral shaft –> cortical bone of the superior aspect of femoral head
lateral = SHEAR/TENSILE FORCES
- arises from the lateral cortex of the superior aspect of the femoral shaft –> crosses medial system –> inferior aspect of femoral head
- result of hip ABD muscle forces + tensile force of body weight
Pelvis acetabular ACCESSORY highway systems (2 main)
Path and what it is the result of….
medial accessory = medial aspect of the superior femoral shaft –> crosses lateral system –> greater trochanter
lateral accessory = runs parallel to greater trochanter
Where is the zone of weakness in the femur?
How is it usually injured?
medial + lateral + lateral accessory
bending forces
Most degenerative changes occur where on the femoral head?
cartilage/dome of the superior portion of the acetabulum and femoral head
o Passive hip range is 90o of hip flexion with the knee extended and 120o-135o with the knee flexed (passive _________tension released)
o Hip extension ranges from 10o to 30o depending if the knee is extended to release passive tension in the _________.
o Femoral abduction ranges from 30o to 50o and can be limited by _______.
o Femoral adduction ranges from 10o to 30o and can be limited by ____ and ____
o Lateral femoral rotation ranges from 45o to 60o (hip flexed to 90o) - _______ by anteversion.
o Medial femoral rotation ranges from 30o to 45o (hip flexed to 90o) – _____ by anteversion.
hamstring
rectus femoris
gracilis
TFL and ITB
decreased
increased
Lateral pelvic tilt
R hip HIKE on L limb stance = ___ hip ___
R hip DROP on L limb stance = ___ hip ___
L HIP ABD
L HIP ADD
Look at where the stance leg/hip is. Is it getting closer or further away from midline?
Pelvic rotation
Forward rotation one of side = ___ rotation of the supporting hip joint
Backward rotation = ____ rotation of the supporting hip
forward = medial rotation of supporting/stance hip
backward = lateral rotation of supporting/stance hip
Again, relative to stance leg
Pt standing on R leg. Lateral pelvic tilt is normal; however, anterior (forward) rotation of the pelvis is present. What accompanying hip joint motion and compensatory lumbar spine motion has occurred?
Hip = R medial rotation L-spine = L rotation
Anterior tilt = HIP FL + Lumbar EX
Posterior tilt = HIP EX + Lumbar FL
R Lateral pelvic drop = R HIP ADD + Lumbar R lateral FL
R Lateral pelvic hike = R HIP ABD + Lumbar L lateral FL
Forward ROT = R MED ROT + Lumbar L ROT
Backward ROT = R LAT ROT + Lumbar R ROT
OK
T or F: lumbar spine is the first line of defense against compensatory actions for the pelvis to maintain head upright
T
