05-03: Limb Length, Girth and Volume

Question 1

Importance of height and weight

Answer 1

• Pt with disorders that may result in abnormal fluid retention
• Determining BMI for overweight/obese categories

Question 2

Disorders with abnormal fluid retention (5)

Answer 2

• Diabetes
• Edema
• Lymphedema
• Venous disease
• Underlying cardiopulmonary disease

Question 3

Standing LLD (Appearance)

Answer 3

One LE appears longer than other, or 1 side of pelvis is elevated

Question 4

Supine LLD (Appearance)

Answer 4

One LE appears longer than other

• Patella not aligned
• Malleoli not aligned

Question 5

Lift and level pelvis

Answer 5

One LE appears longer

Question 6

Assessing limb length - standing

Answer 6

Pelvis level (ASIS, PSIS, Iliac Crest)

Question 7

Assessing limb length - supine

Answer 7

Measure (Compare both limbs, identify which is longer/shorter in relation to the other)

Question 8

Measuring apparent LLD

Answer 8

• Pt supine (hips flexed, knees flexed, back)
• Measure umbilicus to medial mallelolus (inferior, most distal part of malleolus)
• Compare one side to other (if pt measured previously, measure both again to compare with previous)

Question 9

What can alter apparent LLD measurement

Answer 9

• Position of foot,
• Atrophy
• Body mass
• Pelvic obiquity

Question 10

Causes of apparent LLD

Answer 10

• Pelvic obiquity (ASIS and/or PSIS not level)
• Hip adduction deformity (Increased tone can drop pelvis a little bit)
• HIp flexion deformity (may appear shorter because of limb shortening

Question 11

Measuring True LLD

Answer 11

• Pt supine (hips flexed, knees flexed, back)
• Measure ASIS (just inferior to ASIS) to medial mallelolus (bony prominence to bony prominence)
• Compare one side to other (if pt measured previously, measure both again to compare with previous)

*European - ASIS to lateral malleolus (thigh mass may interfere during measurement to lateral malleolus

Question 12

Real leg length

Answer 12

• True leg length

- ASIS to distal medial malleolus

Question 13

Determining location of LLD

Answer 13

• Pt supine, both knees flexed 90˚, feet flat
• one knee higher = longer tibia
• one knee projects further distally = longer femur

Question 14

LLD Correction

Answer 14

• If difference more than 1/2 inch (1 cm), compensate by placing shoe lift in pt shoe
• If pt has weakness and difficulty with swing through, shoe lift in contralateral side (short term(

Question 15

Reasons for limb girth measurements (3)

Answer 15

• Atrophy
• Hypertrophy
• Edema

Question 16

Measuring limb girth

Answer 16

• Use tape measure specifically designed for measuring circumference of limb
• Measure in reference to bony landmarks (specify location, repeat measurements using same landmarks when re-assessing limb girth)
• Measure in consistent increments (multiple, the smaller the increments, the better representation)

Question 17

Measuring Edema

Answer 17

• Girth measurements
• Pitting (Depth of pitting, time of refilling)
• Staging
• Grading

Question 18

Staging Edema (Stage I)

Answer 18

• Reversible edema
• Elevation to reduce swelling
• Pits on pressure

Question 19

Staging Edema (Stage II)

Answer 19

• Spontaneously irreversible lymphedema (fibrous)

- Minimal pitting even with moderate swelling

Question 20

Staging Edema (Stage III)

Answer 20

• Lymphostatic elephantiasis (large limbs)

- Appearance of skin is elephant-like (bumps, skin changes consistency)

Question 21

Grading Edema (all occurs within 30 sec window)

Answer 21

1+ = Indentation is barely detectable
2+ = Slight indentation visible when skin is depressed, returns to normal in 15 sec
3+ = Deeper indentation occurs when pressed and returns to normal within 30 sec
4+ = Indentation lasts for more than 30 sec

Question 22

Interventions for Edema (3)

Answer 22

• Cryotherapy
• Compression
• Elevation

Question 23

Archimede’s Principle

Answer 23

Water volume displaced is equal to the volume of the object immersed in the water

Question 24

Volumeter

Answer 24

Device used to measure volumes of liquids by the amount they displace

Question 25

Volumetric measurements

Answer 25

• Measures edema by amount of water displaced
• Comparison with uninvolved side provides baseline
• Only appropriate for some body parts