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OMM II > Short Leg Syndrome > Flashcards

Short Leg Syndrome Flashcards

1
Q

What is short leg syndrome?

A

A collection of compensatory changes that occurs when there is sacral base unleveling

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2
Q

Where in the spine does short leg syndrome manifest?

A

Lumbar and sacral regions

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3
Q

What are the dirty half-dozen?

A
  1. Nonneutral dysfunction in the lumbar spine
  2. Dysfunction of the pubis
  3. Sacral dysfunction
  4. Up or down slips
  5. Muscle imbalance
  6. Short leg syndrome
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4
Q

What is the presentation of short leg syndrome?

A

Patient will stand and walk differently, eventually resulting in the patient seeking help for pain/ROM

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5
Q

What is the functional short leg?

A
  • Sacral base unleveling d/t SDs that cause one leg to appear shorter than the other
  • No true leg measurement difference
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6
Q

What is the anatomic cause of short leg syndrome?

A

Leg length discrepancy between the left and right lower limbs

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7
Q

Which is more common:anatomic or functional causes of short leg syndrome?

A

Functional

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8
Q

How do you diagnose a small hemipelvis?

A

Higher iliac crest on one side relative to the ITs when sitting

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9
Q

What is the compensatory mechanism for a small hemipelvis?

A

Scoliosis

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10
Q

What is the treatment for a small hemipelvis?

A

Apply IT support

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11
Q

What are the dysfunctions that can cause a functional short leg syndrome?

A
  • Pelvic dysfunction
  • Sacral dysfunction
  • Lumber dysfunction
  • Pronated foot
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12
Q

What muscle contractions can cause a functional short leg syndrome? (2)

A
  • Contraction of psoas

- Tight QL

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13
Q

What are the anatomic causes of short leg syndrome?

A
  • Fracture
  • Cerebral palsy
  • Joint replacement
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14
Q

What is the compensation that occurs at the lumbar spine with short leg syndrome?

A

Scoliosis with convexity on the side of the short leg

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15
Q

What is the compensation that occurs at the innominates with short leg syndrome?

A

Anterior rotation on the side of the short leg

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16
Q

What is the compensation that occurs at the foot with short leg syndrome?

A

Pronation on the side of the long leg

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17
Q

What is the compensation that occurs at the hips with short leg syndrome?

A

Increased stress on side of long leg: may predispose patient to DJD

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18
Q

What is the compensation that occurs at the paravertebral muscles with short leg syndrome?

A

Muscles on the side of the convexity are stretched

Muscles on the side of the concavity are shortened

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19
Q

What is the compensation that occurs at the iliolumbar ligaments with short leg syndrome?

A

Stretched on the side of the short leg (side of the convexity)–this stress can cause a referral of pain to the ipsilateral groin region

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20
Q

What is the compensation that occurs at the SI ligament with short leg syndrome?

A

Can be stressed on both sides. However, the long leg side is more commonly symptomatic

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21
Q

What happens to shoulder height with short leg syndrome?

A

Higher on side of the short leg

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22
Q

What is the most common presentation of short leg syndrome?

A
  • LBP
  • Locking back
  • Pant leg seems longer
  • Unilateral dropped arch
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23
Q

Why is taking account of the duration of the pain with short leg syndrome important?

A

Congential vs acquired (e.g. surgery)

24
Q

What are the SDs that can cause short leg syndrome? (3)

A
  • Upslip
  • Lumbar SD
  • QL issues
25
Q

What may be found on PE with SLS?

A
  • Gross asymmetries
  • Gait abnormalities
  • LROM of the back
26
Q

What are the structural findings that can be found with SLS, when standing? (2)

A

Low or high:

  • iliac crest
  • Greater trochanter heights
27
Q

How can you differentiate SLS vs small hemipelvis?

A

Prone, the spine should be straight, and there should be no leg length discrepancy

28
Q

How many attempts at OMT should be done prior to diagnosing SLS?

A

2-3

29
Q

What are the three major goals of treating SLS?

A

Max balance of:

  • Lumbar spine
  • Osseous pelvis
  • Musculature affecting the pelvis
30
Q

If leg lengths even out following treatment of upslip, is is more likely functional or anatomic?

A

Functional

31
Q

What happens after the treatment of an apparent upslip, when it is actually a true anatomic SLS?

A

Leg discrepancy gets worse

32
Q

What happens to the medial malleoli lengths after treatment of on an upslip, if the issue is an anatomic vs functional SLS?

A 
Anatomic = Worse discrepancy
Functional =  even out
33
Q

When should you evaluate the sacrum for SLS: before or after treatment of innominate shears?

A

After innominate shears have been corrected

34
Q

What area needs to be dysfunction-free before diagnosing SLS?

A

Sacrum

35
Q

What are the muscles that should be evaluated for imbalances with SLS?

A
  • QL
  • Lat dorsi
  • Hip flexors, hamstrings, adductors
36
Q

If the SDs of the QL correct well with suspected SLS, what areas should be evaluated next? What if these areas are improved?

A

Standing landmarks

Functional cause of SLS

37
Q

If treatment of the QL does not balance out the standing landmarks, what should be suspected?

A

Tight QL–trigger pt injection

-May be anatomic dysfunction

38
Q

What is the treatment for true anatomic causes of SLS?

A

-Heel lift therapy

39
Q

What are the three landmarks that should be inspected when prone to evaluate for SLS?

A
  • Iliac crest heights
  • ITs
  • Medial malleolus
40
Q

How can you determine if treating SDs is sufficient for treating SLS AFTER treatment?

A

If the standing flexion test is still positive with normal standing, but is negative with heel lift support

41
Q

What are the two ways to evaluate if a heel lift is an appropriate height?

A

Clinically or radiologically

42
Q

What is the major indication for heel lift therapy?

A

If there is no improvement with OMT

43
Q

What should be assessed for in the foot prior to starting a heel lift orthotic?

A

Pronated foot

44
Q

Under how many mm is a sacral base unleveling tolerable?

A

5 mm

45
Q

What are the three factors that should be taken into consideration when assessing the need for heel lift?

A
  • How bad sacral base unleveling
  • Length of time present
  • Amount of compensation
46
Q

What is the inter and intrarater reliability of x-ray evaluation of SLS?

A

1 mm

47
Q

What is the radiograph that is obtained to evaluate for SLS?

A

Single AP projection of lumbar spine and pelvis

48
Q

What is the indication to start with a smaller heel lift?

A

If the issue is chronic (has compensatory changes)

49
Q

True or false: a heel lift has to be used every time the patient walks

A

True

50
Q

If the SBU is measured in degrees, how do you determine how much heel lift will be needed?

A

1/8th of an inch for every degree of sacral base unleveling

51
Q

If the SBU is measured in length, how do you determine how much heel lift will be needed?

A

if 2 mm of sacral base declination, add 2 mm to heel lift

52
Q

What is the maximum amount of heel lift that can be added inside the shoe?

A

1/4 inch

53
Q

If the patient needs more than 1/4 inch of a heel lift, how should the additional lift be distributed? What should be done if there is still a need for more lift?

A

1/4 inch outside, 1/4 inside

After this, add 1/2 of total lift to the sole

54
Q

What is the Heilig formula?

A

L = [SBU]/[D+C]

55
Q

What are the values of D (duration) in the Heilig formula?

A 
1 = 0-10 years
2 = 10-30 years
3 = 30+ years
56
Q

What are 0, 1, and 2 values for C in the Heilg formula (compensation)?

A

0 = none
1 = rotations of lumbars into convexity
2. Wedging of the vertebrae, spurring

57
Q

True or false: any chronic pain without any identifiable source should be suspicious for SLS

A

True

OMM II (43 decks)

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