This document discusses various evaluation methods used in physical therapy, including anthropometry and limb length and girth measurements. It defines anthropometry as the scientific study of human body measurements and proportions. Limb length discrepancies, including true and apparent leg length discrepancies, are addressed. Proper techniques for measuring limb lengths, segments, and girth using a tape measure are outlined. The document provides detailed instructions on positioning, landmarks, and measuring various upper and lower body parts.

1. EVALUATION METHODS
BY: DR. RACHANA SHAH
MPT(CARDIO)
CMPP

2. OBJECTIVES:
• LIMB LENGTH DISCREPANCIES ( LLD)
• LEG LENGTH DISCREPANCIES
• TRUE AND APPARENT LEG LENGTH DISCREPANCY
• UPPER LIMG LENGTH DISCREPANCY
• GIRTH MEASUREMENT
• MUSCLE BULK
• JOINT EFFUSION/SWELLING
• LIMB GIRTH

3. ANTHROPOMETRY
• ANTHRO: HUMAN(GREEK)
• METRY: MEASUREMENT
• REFERS TO THE MEASUREMENT OF THE HUMAN
BODY
• THE SCIENTIFIC STUDY OF MEASUREMENTS AND
PROPORTIONS OF HUMAN BODY

4. • In physical therapy, anthropometry may include the
assessment of
• Edema
• Localized swelling
• Joint effusion
• Muscular changes
• Asymmetry of body parts
• Effects of surgical procedures
4

6. 6

7. Why measure/Use?
• Aids the clinician in determining the patients
impairments and in providing the appropriate
treatment
• Provides a baseline to monitor the rehabilitation
outcome
• effective treatment vs. patient deterioration
7

8. Why measure/Use? Continued….
• Provides feedback and motivation to patients
• Aids in designing equipment and materials for
special population such as children, elderly and the
differently-abled
8

9. Using the Tape Measure
• Measure in centimeters
• Lie the tape measure flat on the body part
• The tape measure should be stretched out and not
slack
• If the segment to be measured is irregular or conical
in shape, the proximal part of the tape should be
flat
• When measuring circumference, surround the body
part without undue constricting pressure
9

10. Measurements Commonly
Performed in the Clinics
10

11. LIMB LENGTH DISCREPANCY (
LLD)
• Limb length discrepancy or anisomelia, is
defined as a condition in which the paired
upper or lower extremities have a
significantly noticeable unequal length.

12. 1. LIMB LENGTH
• LEG LENGTH
• ARM LENGTH

13. Leg length discrepancy
Definition/Description
• Leg length discrepancy
is defined as a
condition in which the
paired lower extremity
limbs have a noticeably
unequal length.

14. Leg Length Measurement
Indications
 postural deviations
 gait deviations
 checking for leg
length discrepancy

15. Etiological factors
• Idiopathic developmental
abnormalities;
• Fracture;
• Trauma to the epiphyseal
endplate prior to skeletal
maturity;
• Degenerative disorders;
• Legg-calvé- Perthes
disease;
• Cancer or neoplastic
changes;
• Infections;

16. Etiological factors contd..
• Functional:
• Shortening of soft
tissues;
• Joint contractures;
• Ligamentous laxity;
• Axial malalignments;
• Foot biomechanics
(such as excessive ankle
pronation).

17. Classification of leg length discrepancy
(LLD)
• THERE ARE TWO TYPES OF LEG LENGTH
DISCREPANCY.
True leg length discrepancy/ true shortening
Apparent or Functional leg length discrepancy /
apparent or Functional shortening.

18. True LLD
• It is caused by an anatomic or structural change in the
lower leg.
• Resulting from congenital maldevelopment (e.g
adolescent coxa vara, congenital hip dysplasia, bony
abnormality) or trauma( e.g fracture)

19. • As there's an anatomic short leg, the spine and pelvis
are often affected leading to lateral pelvic tilt and
scoliosis.

20. Functional LLD
• It is the result of
compensation for a
change that may have
occurred because of
positioning instead of
structure.
• For example, a
functional LLD may
occur because of
unilateral foot
pronation or spinal
scoliosis.

21. Measuring of true and apparent
leg length

22. Measurement of true leg length
TAPE MEASUREMENT
• POSITIONING:
 Before any measuring is done, the examiner must
set the pelvis square.

23.  The legs should be 15 to 20 cm apart(4 to 8
inches)
 If the legs are not placed in proper relation to the
pelvis, apparent shortening of the limb may occur.

24. • The lower limbs must be placed in comparable
positions relative to the pelvis because
Hip abduction brings medial malleolus closer to
the ASIS on the same side, and;
Hip adduction takes MM farther from the ASIS on
the same side

25. PELVIC SQUARING
• If one hip is fixed in adduc or abduc as a result of
contracture or some other cause , the normal hip
should be adducted or abducted an equal amount
to ensure accurate leg length measurement.

26. • METHOD:
• To obtain the leg length, the examiner measures
from the ASIS to lateral or medial malleolus.
• Leg length measurement is usually taken from the
ASIS to the medial malleolus, however these values
may be altered by muscle wasting or obesity.
• Measuring to the lateral malleolus is less likely be
affected by the muscle bulk.

28. • The flat metal end of the tape measure is placed
immediately distal to the ASIS and pushed up against
it.
• The thumb then presses tape end firmly against the
bone, rigidly fixing the tape measure against the bone.
• The index finger of other hand is placed immediately
distal to the lateral or medial malleolus and pushed
against it.
• The thumb nail is brought down against the tip of the
index finger so that the tape measure is pinched
between them.

29. • A slight difference ( as much as 1 To 1.5 cm) in leg
lengths is considered normal: however this
difference can still cause symptoms.

30. METHOD II
• VISUAL METHOD/ WEBER-BARSTOW MANEUVER
POSITIONING:
The patient lies in supine with hips and knees
flexed

31. • The examiner stands at the patient’s feet and
palpates the distal aspect of the medial malleoli
with the thumbs.
• The pt then lifts the pelvis from the examining table
and returns to the starting position.
• Next, the examiner passively extends the pt’s legs
and compares the positions of the malleoli using
the borders of the thumbs.

33. • If one leg is shorter than the other, the examiner can
determine where the difference is by measuring the
following:
1. From the iliac crest to the greater trochanter of the
femur( for coxa vara or valga)
2. From GT of the femur to the knee joint line on the
lateral aspect( for femoral shaft shortening)
3. From the knee joint line on the medial side to the
medial malleolus (for tibial shaft shortening)

34. The relative length of tibia may also be examined(
visually) with the patient lying prone.
• The examiner places the thumbs transversely
across the soles of the feet just in front of the
heels.
• The knees are flexed to 90 degrees and the relative
height of the thumbs are noted.
• Care must be taken to ensure that the legs are
perpendicular to the examining table.

36. Femoral lengths
• Similarly, femoral
lengths can be
compared by having
the patient lie supine
with the hips and knees
flexed to 90 degrees .
• If one of the femur is
longer than the other,
its height will be higher.

37. APPARENT OR FUNCTIONAL
SHORTENING
• Apparent/ functional shortening of the leg is
evident if the patient has a lateral pelvic tilt when
the measurement is taken.
• Apparent or functional shortening of the limb is
the result of adaptations the patient has made in
response to pathology or contracture somewhere
in the spine, pelvis, or lower limbs.
• In reality, there is no structural or anatomic
difference in bone lengths.

38. • If there were, it would be called true shortening of
the limb

39. MEASUREMENT OF APPARENT
LLD
• When measuring the apparent leg length
shortening, the examiner obtains the distance
from the tip of the xiphisternum or umbilicus to the
medial malleolus.
• IF true leg length is normal but the umbilicus to
malleoIus measurements are different, a functional
leg length discrepancy is present.
• Values obtained by these measurements may be
affected by muscle wasting, obesity, asymmetric
position of the xiphisternum or umbilicus or
asymmetric positioning of the lower limbs.

41. Leg Length Measurement
41

42. STANDING LEG LENGTH:
• BLOCK METHOD:
• Indirect methods.
• Method slightly more reliable & accurate
than use of the tape.
• Patient standing with feet 10cm apart, knees
extended & equal weight on both feet.
• Places his/her hands on bilateral anatomical
structure: ASIS & PSIS left & right.

44. • Visually assesses, if there is a length
inequality, places a wooden board of 0.5cm
under the foot shorter side.
• Keep placing thicker planks under the
shorter side until equal length reached.
• Thickness of plank is equal to the leg length
difference.

45. • Limb Length inequalities-0.5cm to 2.0cm,
common in normal.
• More than 2.5cm –considered significant ,
needs treatment & correction.

46. Upper limb length:

47. Whole upper limb length
• Position:Patient in supine lying. The arm is
positioned in the anatomical position, relaxed at
the side of the subject.
• Measurement is taken from most superior lateral
point of acromion process (acromial landmark) to
the lower and lateral border of styloid process of
radius (radial landmark).

48. Segmental measurement:
Upper arm length:
• Position: Patient in high sitting with arm supported
on pillow. With elbow flexed at 90º, so that ulnar
surface of forearm and hand are horizontal and
palms facing medially with fingers extended,
• Measurement: is taken from acromial landmark to
the posterior surface of olecranon process of ulna.

49. Forearm length:
• Position: Supine or High sitting.
• It is the distance from the head of radius (upper
radial landmark) to the most distal point of the
styloid process of radius (or styloid).

50. Hand length:
• With hand extended and the palm rested in the
direction of the longitudinal axis of forearm,
• measurement is taken from styloid process at base
of thumb to the tip of middle finger.

51. LIMB GIRTH
MEASUREMENT

52. Muscle Bulk Measurement
Indications
• conditions where a
decrease (or increase)
in muscle bulk is
expected
• Atrophy (SCI, fractures,
CVA)
• Hypertrophy (Duchene
muscular dystrophy)

53. Position
• Supine or sitting provided that the segment be
assessed is well supported
Note:
• If the affection is unilateral, measure the
uninvolved extremity prior to measuring the
affected part.
• The muscles should be at rest when muscle bulk is
measured

54. Landmarks
• Identify a stable bony landmark at the proximal
part of the segment to measured (1)
• Identify the area of the segment where the muscle
bulk is the greatest (2)
• Measure the distance between (1) and (2). Record
this as the measurement landmark.

55. Procedure
• Measure the circumference of the segment around
the identified measurement landmark.
• Measure the other extremity using the same
landmarks
BICEPS QUADRICEPS CALF

56. Limitation
• Individual muscles cannot be measured

57. Limb Girth Measurement
Indications
• Swelling
• Joint effusion
• Edema

58. Limb Girth Measurement:
Swelling / Joint effusion
Position
• Supine or sitting provided that the segment be
assessed is well supported
Landmarks
• Identify a stable bony landmark closest to the area
of swelling

59. Limb Girth Measurement: Swelling / Joint effusion
Procedure
• Measure the circumference of
the segment around the
identified measurement
landmark
• Measure every 4 cm (2 inches)
proximally or distally depending
on the extent of the swelling
• Measurement should extend
beyond the obviously involved
area in both directions if at all
possible

60. Limb Girth Measurement:
Swelling / Joint effusion
Procedure
• Measure the other extremity using the same
landmarks to compare
• Measurement should preferably be from a point of
zero difference to another point of zero difference

61. Limb Girth Measurement: For
Edema
Position
• Supine or sitting provided that the segment be
assessed is well supported

62. Limb Girth Measurement: Edema
UPPER LIMB:
• At the Axilla
• 8cm proximal to olecranon.
• 11cm distal to olecranon.
• Wrist.
• Level with web of thumb.

63. Limb Girth Measurement: Edema
LOWER LIMB:
• 15cm below apex of patella.(6inches)
• Apex of patella.
• 5cm above the base of patella.(2 inches)
• 10cm above the base of patella.(4 inches)
• 15cm above the base of patella.(6 inches)
• 23cm above the base of the patella.(9
inches)

64. FIGURE OF EIGHT
MEASUREMENT:
• For Wrist
• Distal aspect of ulnar styloid process, as starting
point.
• The anterior wrist of the most distal aspect of
the radial styloid process.
• Back(dorsum) of the hand & over the fifth MCP
joint line.
• the anterior aspect of the MCP joints & then
diagonally across the back of the hand to where
the tape started.

66. FIGURE OF EIGHT
MEASUREMENT
• For Ankle:
• Patient in long sitting with ankle and lower leg beyond
the end of the examining table with ankle plantigrade
90.
• Places on tibialis anterior tendon,medially across the
instep just distal to the navicular tuberosity.

68. REFERENCES:
• ORTHOPEDIC PHYSICAL ASSESMENT-DAVID J.
MAGEE.(SIXTH EDITION)
• JOINT STRUCTURE AND FUNCTION- PAMELA K.
LEVANGIE,
CYNTHIA C. NORKIN.(FIFTH EDITION)
• TIDY’S PHYSIOTHERAPY-THOMSON,ANN
M.(TWELFTH EDITION)

69. THANK YOU!!