05-03: Limb Length, Girth and Volume Flashcards
Importance of height and weight
- Pt with disorders that may result in abnormal fluid retention
- Determining BMI for overweight/obese categories
Disorders with abnormal fluid retention (5)
- Diabetes
- Edema
- Lymphedema
- Venous disease
- Underlying cardiopulmonary disease
Standing LLD (Appearance)
One LE appears longer than other, or 1 side of pelvis is elevated
Supine LLD (Appearance)
One LE appears longer than other
- Patella not aligned
- Malleoli not aligned
Lift and level pelvis
One LE appears longer
Assessing limb length - standing
Pelvis level (ASIS, PSIS, Iliac Crest)
Assessing limb length - supine
Measure (Compare both limbs, identify which is longer/shorter in relation to the other)
Measuring apparent LLD
- 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)
What can alter apparent LLD measurement
- Position of foot,
- Atrophy
- Body mass
- Pelvic obiquity
Causes of apparent LLD
- 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
Measuring True LLD
- 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
Real leg length
- True leg length
- ASIS to distal medial malleolus
Determining location of LLD
- Pt supine, both knees flexed 90˚, feet flat
- one knee higher = longer tibia
- one knee projects further distally = longer femur
LLD Correction
- 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(
Reasons for limb girth measurements (3)
- Atrophy
- Hypertrophy
- Edema
Measuring limb girth
- 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)
Measuring Edema
- Girth measurements
- Pitting (Depth of pitting, time of refilling)
- Staging
- Grading
Staging Edema (Stage I)
- Reversible edema
- Elevation to reduce swelling
- Pits on pressure
Staging Edema (Stage II)
- Spontaneously irreversible lymphedema (fibrous)
- Minimal pitting even with moderate swelling
Staging Edema (Stage III)
- Lymphostatic elephantiasis (large limbs)
- Appearance of skin is elephant-like (bumps, skin changes consistency)
Grading Edema (all occurs within 30 sec window)
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
Interventions for Edema (3)
- Cryotherapy
- Compression
- Elevation
Archimede’s Principle
Water volume displaced is equal to the volume of the object immersed in the water
Volumeter
Device used to measure volumes of liquids by the amount they displace
Volumetric measurements
- Measures edema by amount of water displaced
- Comparison with uninvolved side provides baseline
- Only appropriate for some body parts
