Short Leg Syndrome Flashcards
Define short leg syndrome - coronal and saggital changes.
coronal - short leg
saggital - pelvic tilt
What happens structurally to the feet in flat feet - pes planus
OVERPRONATED AND INTERNALLY ROTATED hip compensation
Define the Salter Harris classification types.
Which would affect growth?
Type 1 and 2: growth plate unaffected
Type 3 and 4: plate broken, may bridge
Type 5: crushed injury resulting in bone to bone fusion
types 3, 4, 5 would affect growth
What is the structural growth etiology of the hip joint in an obese teenager with a painful limp?
Slipped Capitol Femoral Epiphysis
What is the structural growth etiology of the hip joint in a child age 4-10 with a painless limp? What can result?
LEGG – CALVE – PERTHES disease
Avascular necrosis can result
Innominate rotation falsely lengthens or shortens legs. Name the possible causes of rotation:
-Ligament strain.
-Muscular Contraction:
Adductors - attach from ___ to ___
Hip Flexors - attach from ___ and ___ to ___ –> Tight hip flexors cause what rotation?
Hamstrings - attach from ___ to ___ –> Tight hamstrings cause what rotation?
Adductors – attach from pubic ramus to femur.
Hip Flexors – attach from iliac fossa & lumbar spine to lesser trochanter of femur. Tight hip flexors cause ANTERIOR ROTATION LENGTHENS LEG.
Hamstrings – attach from ischial tuberosity to tibia or fibula or both. Tight hamstrings cause POSTERIOR ROTATION SHORTENS LEG.
If someone has an EXTERNAL ROTATION of the leg, you would expect that side to be taller or shorter?
shorter on the ER side
If the pelvis were rotated anteriorly on the left, (ASIS anterior and inferior) would the leg
appear to be:
SHORTER or LONGER?
anterior rotation lengthens the leg
posterior rotation shortens the leg
If the innominate were rotated anteriorly [saggital plane] on the right (like the past example) would the iliac crest on that side be:
Higher? Or Lower?
higher
Where is the center of gravity around? What vertebral level?
center of gravity is about S2
Name the evaluation of posture - what areas?
- External Auditory Meatus
- Tip of the Acromion
- Center of the body of 3rd Lumbar Vertebrae
- Through the center of the Knee
- Just anterior to lateral malleolus
Why are there compensatory curves in the spine due to an unlevel sacral base?
To keep eyes level with the horizon and maintain sense of place and position.
Is this an early or late postural compensatory change?
Spine tends toward a “C” shape curve with convexity on side of short leg. *Shoulder on short leg side more superior
EARLY
Everything SB away from short leg early on.
(short R leg = lumbar spine SB L –> COT to upper thoracics SB R to make “S shape”
Is this an early or late postural compensatory change?
Spine’s compensatory mechanism distribute forces over several lateral curves. “S” shaped curve. *Shoulder on short leg side more inferior
LATE
Postural Compensatory changes - Innominate on short leg side v. long leg side.
Short leg anteriorly rotates.
Long leg posteriorly rotates.
Postural Compensatory changes - Pelvis side shifts and rotates around the transverse plane to the short or long side?
pelvis shifts toward long leg side
Postural Compensatory changes - On long leg side the foot is pronated, causing what change?
internally rotating the ipsilateral hip
Tight hamstrings (long side) on one thigh and tight rectus femoris (short leg) on opposite thigh. What plane changes and short side has which muscle tightness?
Pelvic transverse plane changes
Short side - rectus femoris tight
Tight abductor (long side) on one side with tight adductors (short leg) on opposite thigh. What plane changes and short side has which muscle tightness?
Pelvic coronal plane changes
Short side - adductors tight
***Iliolumbar ligament of lumbroacral convex/cavity? Not is painful on what side?
convexity - the SHORT leg side.
pain refers to hip and groin
(connects L4-L5 to ASIS)
Gold standard for evaluation of leg length.
evaluate what three levels?
Standing radiograph to determine amount of sacral base unleveling.
evaluation iliac crest, sacral base, and femoral head levels.
normal ferguson’s angle.
25-35 degrees
What is the Heilig Formula?
L = [SBU] / [D+C]
L: Lift required
SBU: Sacral Base Unleveling (determine with the lines)
D: Duration of dysfunction
1= 0-10; 2 = 10-30; 3 = 30+ years
C: Compensation. 0 = none; 1 = rotation of vertebrae into compensatory sidebending; 2 = wedging of vertebrae
When leg length discrepancy is greater than __mm go do lift therapy.
If spine is flexible with mild-moderate scoliosis, begin and increase how much?
If spine is fragile, begin and increase how much?
greater or equal to 5mm
1/8 inch and increase every 2 weeks
1/16 inch and increase every 2 weeks
