Short leg syndrome/Scoliosis Flashcards
scoliosis
coronal curve greater than 5 degrees
group postural curves
spinal side bending and rotation opposite ?
in the sagittal plane how does gravity encourage the sacral base to move? innominates?
sacral base–> anterior rotation
innominates posterior rotation about the femoral head
increases lordotic and kyphotic curves
compensatory changes in the coronal plane
what happens to the lumbar spine
what happens to the pelvis
lumbar spine
-bends away from and rotates toward the lower sacral base
pelvis
-side shifts and rotates around a vertical axis toward the long leg side
innominate may compensate and try to rotate anteriorly on the side of the short leg
what happen to the foot on the long leg side
pronated and the lower extremity internally rotates
why is short leg syndrome a misnomer
b/c there isn’t actually a short leg there is an unlevel sacral base and the innominates then compensate creating a false picture of a short leg
what is the most common spinal response pattern to unlevel sacral base
sidebending of the most caudal curve is away from the side of the low sacral base and usually on the side of the short leg
what is a better test to assess short leg syndrome than measuring ASIS or hip to ankle or medial malleoli
radiographic measurements
tissues on the concavity of the curve demonstrate what characteristics
shorten- fibrotic
increased electromyographic activity
tissues on the convex side of the curve?
lengthen and weaken
significance of iliolumbar ligament
often this ligament on the side of the convexity is the first structure to react to added stress in the lumbosacral area
can radiate pain to groin region
can mimic hip pain
treatment of short leg syndrome
lift the heel of the leg on the side of the depressed sacral base
don’t treat until OMT has been done first
what must you consider in children when using leg lifts
compressive forces makes bone grow faster
pt is fragile (arthritic, osteoporotic, elderly)
begin with what length of heel lift
1/16th in life and lift no faster than 1/16 of an inch every 2 weeks
pt has flexible spine and no more than mild to moderate strain in the myofascial system
begin with what length of heel lift
1/8 in lift and lift at rate no faster than 1/16 th of an inch per week or 1/8 inch every two weeks
if there was a recent and sudden loss of length on one side as might occur following fx or hip prosthesis, what heel lift should you begin with
lift the full amount that was lost
how do you name scolisosis
it is more common in girls to have progressive symptoms
name for side of convexity (so if side bent left its a right curve)
by what 4 ways can you classify scolisosis
reversibility, severity, cause or location
reversibility of scolisosis
functional or not
severity of scoliosis
using Cobb method - mild, modest or severe
significant progression is considered to be occurring if an X-ray taken 5 months after the initial shows 5 degree or greater increase in curvature
mild - 5-15 degrees
moderate - 20-45 deg
severe - 50 degree
acquired causes of scolisosis
osteomalacia response to inflammation or irradiation sciatic irritability psoas syndrome healed leg fracture following a hip prosthesis
difference b/w balanced and unbalanced curves
balanced - subject to degeneration at crossovers
unbalanced are more likely to decompensate
most common type of scolisosis
double major scoliosis
two curves - lumbar and thoracic
2nd most common scoliosis
single thoracic scoliosis
