This document provides information on limb length measurement and discrepancies. It defines true and apparent limb length measurement and describes various methods to measure limb lengths, including using a tape measure between bony landmarks or blocks under the shorter limb. Causes of limb length discrepancies include fractures, infections, bone diseases, tumors and more. Supra-trochanteric and infra-trochanteric shortening are distinguished and different measurement techniques are outlined for each.
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
The document discusses leg length discrepancies, which can be true differences in bone length or functional differences caused by other factors like joint issues. It describes how to evaluate for pelvic obliquity and measure leg lengths to determine if a true or functional discrepancy is present, including measuring from bony landmarks to compare lengths directly or using other anatomical reference points. The causes and types of true and functional discrepancies are also outlined.
The knee is a complex joint composed of the tibiofemoral and patellofemoral joints. It functions to provide mobility and support body weight during both static and dynamic activities. The knee joint contains menisci that increase joint congruence and distribute weight forces. It also contains cruciate and collateral ligaments that restrict motion and provide stability. During flexion and extension, the tibia glides and rotates on the femur through rolling and sliding motions controlled by the ligaments and menisci.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.
this PPT contain detailed kinetics & kinematics of ankle joint & all joints of foot complex, muscles of ankle & foot complex, plantar arches & weight distribution during standing.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
The document discusses leg length discrepancies, which can be true differences in bone length or functional differences caused by other factors like joint issues. It describes how to evaluate for pelvic obliquity and measure leg lengths to determine if a true or functional discrepancy is present, including measuring from bony landmarks to compare lengths directly or using other anatomical reference points. The causes and types of true and functional discrepancies are also outlined.
The knee is a complex joint composed of the tibiofemoral and patellofemoral joints. It functions to provide mobility and support body weight during both static and dynamic activities. The knee joint contains menisci that increase joint congruence and distribute weight forces. It also contains cruciate and collateral ligaments that restrict motion and provide stability. During flexion and extension, the tibia glides and rotates on the femur through rolling and sliding motions controlled by the ligaments and menisci.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
BIOMECHANICS OF HIP JOINT BY Dr. VIKRAMVicky Vikram
The hip joint is a ball-and-socket joint that allows flexion, extension, abduction, adduction, and rotation. It is formed by the acetabulum of the pelvis articulating with the femoral head. The primary function is to support the weight of the upper body. Key biomechanical aspects include the angles of inclination and torsion of the femur, congruence of the joint surfaces, and forces transmitted during weight bearing that are balanced by the joint capsule and trabecular bone structure. Motion occurs through tilting and rotation of the pelvis on a fixed femur. Surrounding muscles provide dynamic stability and control movement.
this PPT contain detailed kinetics & kinematics of ankle joint & all joints of foot complex, muscles of ankle & foot complex, plantar arches & weight distribution during standing.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
Recurrent Dislocation of patella -PAWANPawan Yadav
This document discusses recurrent patellar dislocation. It begins by defining recurrent patellar dislocation as the patella shifting laterally with minimal stress on knee flexion. It then discusses the anatomy and Q angle as well as predisposing causes such as increased Q angle, weak medial quads, and tight lateral structures. The document outlines clinical features, tests, x-ray findings, and treatment options including conservative immobilization and surgical procedures like realignment and patellectomy.
Limb length discrepancy can be structural or functional. For structural discrepancies between 2-5 cm in growing children, epiphysiodesis is commonly used to modulate growth. Epiphysiodesis involves arresting growth in the long limb's growth plate to allow the short limb time to catch up. It is a relatively simple procedure but risks include under or overcorrection and asymmetric growth arrest. For discrepancies over 5 cm or in skeletally mature individuals, shortening the long limb is preferred over lengthening the short limb.
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
The document discusses the anatomy and biomechanics of the hip joint. It describes the ball and socket structure of the hip joint formed by the acetabulum and femoral head. It details the angles of the hip joint including the central edge angle and angle of anteversion. It discusses the muscles, ligaments, biomechanics including ranges of motion, and forces across the hip joint during activities like standing, walking, and squatting. Pathomechanics of conditions like hip fractures and dislocations are also mentioned.
Arthrodesis refers to the surgical fusion of a joint. It is indicated for pain and instability in the joint. With improvements in joint replacement surgery, arthrodesis is now less commonly performed. It permanently relieves pain by fusing the bones and eliminating joint movement, at the cost of stiffness. The optimal positions for fusing different joints are described. Common complications include malposition and nonunion.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
Posture - a perquisite for functional abilities in daily life. Posture is a combination of anatomy and physiology with inherent application of bio-mechanics and kinematics. Sitting, standing, walking are all functional activities depending on the ability of the body to support that posture to carry out each activity. Injuries and pathologies either postural or structural can massively change the bio-mechanics of posture and thus affect functional abilities.
The document discusses gait and the gait cycle. It defines gait as a person's pattern of walking and notes walking patterns can differ between individuals. The gait cycle is defined as the period from one heel strike to the next heel strike of the same limb. The gait cycle consists of the stance phase, when the foot is on the ground, and the swing phase, when the foot is off the ground. Temporal and distance variables are used to analyze gait, including single limb support time, stride length, and degree of toe out. The document also reviews the kinematics and kinetics of normal gait.
This document discusses total knee replacement (TKR) and the physiotherapy rehabilitation process. It covers pre-surgical physiotherapy focusing on strength and mobility. Post-surgical physiotherapy is divided into phases focusing initially on range of motion and strengthening, then adding balance and proprioception training. The goals and key exercises of each phase are outlined in detail over 12 weeks of recovery. Complications of TKR like infection, loosening and failure are also mentioned.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Proper tensioning and protection are important surgically and post-operatively in rehabilitation to train the tendon and patient. Overall, tendon transfers aim to restore function through redistributing muscle forces.
This document provides an overview of the anatomy of the knee joint. It describes the bones that make up the knee (femur, tibia, patella). It then discusses the tibiofemoral joint and patellofemoral joint. It provides details on the degrees of freedom in the knee joint and the ligaments, menisci, and other structures that are involved in the knee joint.
This document describes various mat activities (MAT) used in physical therapy. It discusses 9 principles of MAT including concentration, control, fluidity, etc. It then describes different MAT positions and exercises including rolling, prone on elbows, prone on hands, supine on elbows, pull ups, lifting, quadruped position, kneeling, and sitting. The goals of MAT are to facilitate balance, promote stability, mobilize and strengthen the trunk and limbs, and train for functional activities. Details are provided on how to perform several example MAT exercises and positions.
This document provides information on posture assessment, including history taking, observation, and functional testing. Observation involves using a plumb line to evaluate posture from the lateral, anterior, and posterior views in both standing and sitting positions. Common deviations like lordosis, kyphosis, and scoliosis are described. Functional tests evaluate soft tissue and bony restrictions. The goal of assessment is to identify postural deviations and musculoskeletal issues.
Upper limb prostheses are designed to replace missing limbs and restore function. A successful prosthesis is comfortable, easy to use, lightweight, durable, cosmetically pleasing, and mechanically sound. Prosthesis type depends on amputation level, expected use, patient factors, and resources. Terminal devices can be passive hooks/hands or myoelectric hands. Wrists, elbows, and shoulders provide anatomical movement. Suspension systems secure the prosthesis comfortably. Control mechanisms may be body-powered cables or electric switches/signals. Prosthesis components and design vary according to the amputation level and length of residual limb.
Limb length discrepancy can be congenital or acquired. It is defined as a difference in leg length of 2.5 cm or more. A short leg causes an awkward gait, increased energy expenditure, and back pain. Treatment depends on the severity and includes shoe lifts for mild cases and epiphysiodesis, shortening, or lengthening procedures for larger discrepancies. Limb lengthening uses either external fixators like the Ilizarov or internal devices to gradually lengthen the bone through the process of distraction osteogenesis, where the bone is slowly pulled apart to stimulate new bone growth. Treatment must be tailored based on the individual's age, growth remaining, and specific condition.
This document discusses orthotics and their use in rehabilitation. It begins by describing how bioengineering devices like orthotics play an important role in orthopedic and neurological rehabilitation by improving function and support. It then discusses different types of orthotics in more detail, including their components, classifications, indications for use, and general principles. Specific orthotics for the ankle, knee, and hip are also outlined.
This document discusses active and passive insufficiency in muscles. Active insufficiency occurs when a multi-joint muscle shortens over both joints simultaneously, losing tension. Passive insufficiency occurs when a multi-joint muscle is lengthened to its fullest extent at both joints, preventing full range of motion. Examples given are the rectus femoris causing active insufficiency in hip flexion and knee extension together, and the flexor digitorum profundus losing the ability to make a tight fist when the wrist is flexed. The relationship between them is that when the agonist contracts, the antagonist relaxes or lengthens, so the extensibility of the antagonist can limit the agonist's capability,
This document provides an overview of limb length discrepancy, including leg length inequality and angular deformities. It discusses the causes, impact, assessment, and prediction of leg length inequality in children. Key points include:
- Leg length discrepancies of 0.5-2cm are common, while over 2.5cm can cause back/joint pain due to abnormal gait.
- Causes include congenital factors, trauma, infection, or irradiation damaging growth plates.
- Assessment involves history, exam including blocks under the short leg, and imaging like radiography or CT to measure discrepancy.
- Several methods can predict remaining growth, like the Anderson-Green-Messner charts or Moseley straight-line graph
Limb length discrepancy can be structural or functional in nature. Structural discrepancies result from actual differences in bone length, while functional discrepancies appear due to other factors like pelvic tilt. Discrepancies over 2.5 cm are considered significant and can be classified as mild, moderate, or severe based on the size of the difference. Treatment depends on the size of the discrepancy and may include orthotics, epiphysiodesis, shortening osteotomies, limb lengthening procedures, or amputation in more severe cases. The goals of treatment are to achieve balanced alignment of the spine and pelvis and equalize limb lengths.
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
Recurrent Dislocation of patella -PAWANPawan Yadav
This document discusses recurrent patellar dislocation. It begins by defining recurrent patellar dislocation as the patella shifting laterally with minimal stress on knee flexion. It then discusses the anatomy and Q angle as well as predisposing causes such as increased Q angle, weak medial quads, and tight lateral structures. The document outlines clinical features, tests, x-ray findings, and treatment options including conservative immobilization and surgical procedures like realignment and patellectomy.
Limb length discrepancy can be structural or functional. For structural discrepancies between 2-5 cm in growing children, epiphysiodesis is commonly used to modulate growth. Epiphysiodesis involves arresting growth in the long limb's growth plate to allow the short limb time to catch up. It is a relatively simple procedure but risks include under or overcorrection and asymmetric growth arrest. For discrepancies over 5 cm or in skeletally mature individuals, shortening the long limb is preferred over lengthening the short limb.
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
The document discusses the anatomy and biomechanics of the hip joint. It describes the ball and socket structure of the hip joint formed by the acetabulum and femoral head. It details the angles of the hip joint including the central edge angle and angle of anteversion. It discusses the muscles, ligaments, biomechanics including ranges of motion, and forces across the hip joint during activities like standing, walking, and squatting. Pathomechanics of conditions like hip fractures and dislocations are also mentioned.
Arthrodesis refers to the surgical fusion of a joint. It is indicated for pain and instability in the joint. With improvements in joint replacement surgery, arthrodesis is now less commonly performed. It permanently relieves pain by fusing the bones and eliminating joint movement, at the cost of stiffness. The optimal positions for fusing different joints are described. Common complications include malposition and nonunion.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
Posture - a perquisite for functional abilities in daily life. Posture is a combination of anatomy and physiology with inherent application of bio-mechanics and kinematics. Sitting, standing, walking are all functional activities depending on the ability of the body to support that posture to carry out each activity. Injuries and pathologies either postural or structural can massively change the bio-mechanics of posture and thus affect functional abilities.
The document discusses gait and the gait cycle. It defines gait as a person's pattern of walking and notes walking patterns can differ between individuals. The gait cycle is defined as the period from one heel strike to the next heel strike of the same limb. The gait cycle consists of the stance phase, when the foot is on the ground, and the swing phase, when the foot is off the ground. Temporal and distance variables are used to analyze gait, including single limb support time, stride length, and degree of toe out. The document also reviews the kinematics and kinetics of normal gait.
This document discusses total knee replacement (TKR) and the physiotherapy rehabilitation process. It covers pre-surgical physiotherapy focusing on strength and mobility. Post-surgical physiotherapy is divided into phases focusing initially on range of motion and strengthening, then adding balance and proprioception training. The goals and key exercises of each phase are outlined in detail over 12 weeks of recovery. Complications of TKR like infection, loosening and failure are also mentioned.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Proper tensioning and protection are important surgically and post-operatively in rehabilitation to train the tendon and patient. Overall, tendon transfers aim to restore function through redistributing muscle forces.
This document provides an overview of the anatomy of the knee joint. It describes the bones that make up the knee (femur, tibia, patella). It then discusses the tibiofemoral joint and patellofemoral joint. It provides details on the degrees of freedom in the knee joint and the ligaments, menisci, and other structures that are involved in the knee joint.
This document describes various mat activities (MAT) used in physical therapy. It discusses 9 principles of MAT including concentration, control, fluidity, etc. It then describes different MAT positions and exercises including rolling, prone on elbows, prone on hands, supine on elbows, pull ups, lifting, quadruped position, kneeling, and sitting. The goals of MAT are to facilitate balance, promote stability, mobilize and strengthen the trunk and limbs, and train for functional activities. Details are provided on how to perform several example MAT exercises and positions.
This document provides information on posture assessment, including history taking, observation, and functional testing. Observation involves using a plumb line to evaluate posture from the lateral, anterior, and posterior views in both standing and sitting positions. Common deviations like lordosis, kyphosis, and scoliosis are described. Functional tests evaluate soft tissue and bony restrictions. The goal of assessment is to identify postural deviations and musculoskeletal issues.
Upper limb prostheses are designed to replace missing limbs and restore function. A successful prosthesis is comfortable, easy to use, lightweight, durable, cosmetically pleasing, and mechanically sound. Prosthesis type depends on amputation level, expected use, patient factors, and resources. Terminal devices can be passive hooks/hands or myoelectric hands. Wrists, elbows, and shoulders provide anatomical movement. Suspension systems secure the prosthesis comfortably. Control mechanisms may be body-powered cables or electric switches/signals. Prosthesis components and design vary according to the amputation level and length of residual limb.
Limb length discrepancy can be congenital or acquired. It is defined as a difference in leg length of 2.5 cm or more. A short leg causes an awkward gait, increased energy expenditure, and back pain. Treatment depends on the severity and includes shoe lifts for mild cases and epiphysiodesis, shortening, or lengthening procedures for larger discrepancies. Limb lengthening uses either external fixators like the Ilizarov or internal devices to gradually lengthen the bone through the process of distraction osteogenesis, where the bone is slowly pulled apart to stimulate new bone growth. Treatment must be tailored based on the individual's age, growth remaining, and specific condition.
This document discusses orthotics and their use in rehabilitation. It begins by describing how bioengineering devices like orthotics play an important role in orthopedic and neurological rehabilitation by improving function and support. It then discusses different types of orthotics in more detail, including their components, classifications, indications for use, and general principles. Specific orthotics for the ankle, knee, and hip are also outlined.
This document discusses active and passive insufficiency in muscles. Active insufficiency occurs when a multi-joint muscle shortens over both joints simultaneously, losing tension. Passive insufficiency occurs when a multi-joint muscle is lengthened to its fullest extent at both joints, preventing full range of motion. Examples given are the rectus femoris causing active insufficiency in hip flexion and knee extension together, and the flexor digitorum profundus losing the ability to make a tight fist when the wrist is flexed. The relationship between them is that when the agonist contracts, the antagonist relaxes or lengthens, so the extensibility of the antagonist can limit the agonist's capability,
This document provides an overview of limb length discrepancy, including leg length inequality and angular deformities. It discusses the causes, impact, assessment, and prediction of leg length inequality in children. Key points include:
- Leg length discrepancies of 0.5-2cm are common, while over 2.5cm can cause back/joint pain due to abnormal gait.
- Causes include congenital factors, trauma, infection, or irradiation damaging growth plates.
- Assessment involves history, exam including blocks under the short leg, and imaging like radiography or CT to measure discrepancy.
- Several methods can predict remaining growth, like the Anderson-Green-Messner charts or Moseley straight-line graph
Limb length discrepancy can be structural or functional in nature. Structural discrepancies result from actual differences in bone length, while functional discrepancies appear due to other factors like pelvic tilt. Discrepancies over 2.5 cm are considered significant and can be classified as mild, moderate, or severe based on the size of the difference. Treatment depends on the size of the discrepancy and may include orthotics, epiphysiodesis, shortening osteotomies, limb lengthening procedures, or amputation in more severe cases. The goals of treatment are to achieve balanced alignment of the spine and pelvis and equalize limb lengths.
Anthropometry involves measuring the human body to assess things like body composition, edema, and limb symmetry. Key anthropometric measurements include length, circumference, width, and skinfold thickness using tools like a tape measure, calipers, and stadiometer. Examples provided include leg length discrepancy tests, Schober's test, and taking girth measurements of various body parts like waist, calf, and ankle. Anthropometric measurements can help clinicians evaluate impairments and monitor rehabilitation progress.
1) Limb length discrepancy (LLD) can be congenital or acquired and causes include trauma, infections, tumors, or bone diseases. It is classified as mild (<3cm), moderate (3-6cm), or severe (>6cm) based on the magnitude of inequality.
2) Assessment of LLD involves history, physical exam including block tests and measurements, and imaging like radiographs. Compensations can include gait disturbances, back pain, and deformities.
3) Management depends on skeletal maturity and can include shoe lifts, epiphysiodesis to slow long bone growth, acute shortening/lengthening procedures, or gradual lengthening with external or internal fixation devices.
This document discusses leg length discrepancy (LLD), which is when the paired lower extremities have an unequal length. There are two types of LLD - structural (true) shortening caused by anatomical changes, and functional (apparent) shortening from positioning. Causes of LLD include developmental abnormalities, soft tissue shortening, degenerative disorders, trauma, and fractures. LLD is measured from the anterior superior iliac spine to the medial malleolus, with 1-1.5cm being normal. Additional measurements may be needed depending on the location of shortening. Visual tests like the Weber Barstow Maneuver can also detect LLD.
1. A skeletal dysplasia is a congenital abnormality of bone growth or development that results in structural abnormalities of the bones.
2. Making a diagnosis involves taking a thorough history and physical examination, including measurements of height, limb lengths, and facial features. Radiographs can identify which bones are affected.
3. Achondroplasia is the most common skeletal dysplasia, caused by a mutation in the FGFR3 gene, and is characterized by disproportionate short stature, frontal bossing, trident hands, genu varum, and foramen magnum stenosis.
EVALUATION METHODS.presentation for evaluationPranavTrehan2
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.
Hip dysplasia occurs when the ball and socket of the hip joint are misaligned, causing discomfort and pain. It can develop during childhood or adolescence. Treatment options range from physical therapy and medications for mild cases to surgical procedures like hip arthroscopy or osteotomy to realign the socket for more severe cases. The goal is to keep the ball centered in the socket to reduce friction and risk of further damage leading to osteoarthritis.
Limb length discrepancy can be structural, resulting from actual differences in bone length, or functional, caused by other factors like muscle imbalance. Evaluation involves history, exam including gait and specific tests, and imaging like x-rays. Treatment depends on severity but may include shoe lifts for mild cases, guided growth for moderate, and surgery like epiphysiodesis, shortening, or lengthening for more severe discrepancies. The goal is balanced posture, equal lengths, and proper weight bearing.
1. The document discusses canine hip dysplasia, describing its pathogenesis, stages, clinical signs, diagnosis and treatment options.
2. Key diagnostic tests include orthopedic examination, hip-extended radiography, distraction radiography and various hip scoring systems.
3. Treatment involves non-surgical options like weight control, physical therapy and medications or surgical options like juvenile pubic symphysiodesis, triple pelvic osteotomy or femoral head and neck ostectomy.
This document discusses the history and development of the Ilizarov fixator for limb lengthening. Some key points:
- Previous methods from the 1940s-1960s by Anderson and Wagner were crude, requiring multiple invasive surgeries and resulting in many complications.
- Soviet physician Gavriil Ilizarov in the 1940s-50s pioneered a circular external fixator made of thin wires that could gradually and safely lengthen limbs using the body's natural bone regeneration, establishing the biological principles still used today.
- His method reduced complications and made limb lengthening a reliable procedure to treat many causes of limb length discrepancies and shortening.
Ergonomics is a vastly discussed topic in all fields...right from day to day activities to highly skilled Professions like Dentistry.lets have a quick look at what all we need to be careful about, to lead a healthy dental career.
smile and make others smile ....;)
An effort to put light on the common health hazards caused by improper ergonomics and a glance over the proper ergonomic practises to be followed in daily dental practise to increase the ease and efficiency of your practise..
Equinus Management for Improved Patient Outcomespadeheer
Equinus, or limited ankle dorsiflexion, is frequently an underlying cause of many foot and ankle pathologies. The document discusses several studies that show equinus is very common, present in over 90% of patients with foot or ankle symptoms. One study found that treating the underlying equinus deformity, rather than just orthotics, improved outcomes for patients. The gastrocnemius muscle is a major contributor to equinus contractures. Assessing for gastrocnemius tightness should be part of any foot and ankle examination. Effectively treating equinus can help address many foot and ankle issues.
Limb-length discrepancy can be caused by structural, functional, or environmental factors that result in one leg being longer or shorter than the other. Symptoms of discrepancy include an awkward gait, back pain, and compensatory scoliosis. Discrepancies are classified as mild (<3cm), moderate (3-6cm), or severe (>6cm). Treatment depends on the magnitude of discrepancy and may include shoe lifts for mild cases, growth modulation for moderate, and limb lengthening or shortening surgery for severe discrepancies. The goal of treatment is to alleviate symptoms and prevent long-term complications.
A 24-year-old female presented with bilateral genu vulgum (knock knees), more pronounced on the right side at 25 degrees, likely due to a metabolic issue. Genu vulgum is an abnormal angular deformity of the lower limbs where the legs are shifted outward from the midline. Treatment depends on the patient's age, magnitude of deformity, location of deformity, and underlying cause. For younger patients or less severe cases, conservative treatment may be sufficient, while older patients or more severe cases may require corrective osteotomy surgery.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Duccheene muscular dystrophy
Duchenne muscular dystrophy (DMD) is a severe type of muscular dystrophy. The symptom of muscle weakness usually begins around the age of four in boys and worsens quickly. Typically muscle loss occurs first in the thighs and pelvis followed by those of the arms. This can result in trouble standing up. Most are unable to walk by the age of 12. Affected muscles may look larger due to increased fat content. Scoliosis is also common. Some may have intellectual disability. Females with a single copy of the defective gene may show mild symptoms.
The document discusses extrapyramidal disorders and basal ganglia disorders. It provides information on:
- The extrapyramidal system and basal ganglia, which are involved in motor control and other functions.
- Movement disorders are divided into hyperkinetic disorders involving excessive movements (chorea, dystonia) and hypokinetic disorders with diminished movement (akinesia, bradykinesia, rigidity).
- Lesions in the basal ganglia can cause specific movement disorders like athetosis, dystonia, bradykinesia, rigidity, tremor, and others.
- Parkinson's disease is discussed as a primary hypokinetic disorder caused by degeneration of dopaminergic
Mirror neurons are neurons that fire both when an individual performs an action and when they observe the same action being performed by another. Mirror therapy uses a mirror to create the visual illusion that a paralyzed or weakened limb is moving normally. It activates the patient's mirror neuron system and has been shown to improve motor function and reduce pain in various conditions such as stroke, complex regional pain syndrome, phantom limb pain, and Parkinson's disease. The mechanism involves activation of the motor cortex through visual feedback that stimulates neuroplasticity and motor learning. Precautions include ensuring a coherent mirror image and avoiding risks of injury or distraction.
The document provides an overview of the Reproductive and Child Health (RCH) Program in India. It describes the various components of the program including family planning, child survival, safe motherhood, sexually transmitted diseases/reproductive tract infections, and adolescent health. It outlines the goals, target groups, services, and new initiatives of the RCH program. Key aspects of the program include expanding access to maternal and child healthcare, reducing maternal and child mortality, and achieving population stabilization. The document also discusses monitoring indicators and strategies for evaluating the impact of the RCH program.
The document discusses the 12 pairs of cranial nerves. It provides details on their origin, innervation, function and clinical evaluation. Some key points:
- The cranial nerves originate from the brain and have both sensory and motor functions. They are assessed based on their specific functions like eye movement, facial expression, hearing and balance.
- CN III, IV and VI are involved in eye movement. CN VII controls facial expression. CN VIII has roles in hearing and balance. CN IX and X are related to swallowing, gag reflex and autonomic functions.
- Clinical tests evaluate senses like smell, vision, hearing and taste as well as motor skills controlled by each nerve. Signs of dysfunction include
This document discusses the management of infertility. It begins with definitions and classifications of infertility. Evaluation involves a medical history and physical exam for both males and females. Common causes of infertility in males include infection, trauma, and exposure to toxins, while common causes in females include disorders of ovulation, fallopian tube damage or blockage, endometriosis, and uterine issues. Treatment options discussed include counseling, lifestyle changes, ovulation induction with clomiphene or aromatase inhibitors, gonadotropins, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection. The goal is to stimulate follicle development and ovulation or perform fertilization procedures to increase the chances of conception.
This document discusses genetic disorders and mutations. It covers several key topics: types of genetic disorders like single gene, chromosomal, and multifactorial disorders; different types of mutations like point mutations, deletions, and repeats; patterns of inheritance like autosomal dominant, recessive, and sex-linked; specific genetic disorders and the genes/chromosomes involved; and techniques for studying chromosomes like karyotyping, FISH, and spectral karyotyping. Common chromosomal disorders discussed include Down syndrome, Klinefelter syndrome, and Turner syndrome. The document provides an overview of genetic concepts, disorders, and terminology.
This document provides information on first and second line antitubercular drugs. It lists the main first line drugs as isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin and describes their mechanisms of action, pharmacokinetics, uses, doses and side effects. Second line drugs discussed include fluoroquinolones, macrolides, ethionamide and cycloserine. Details are provided on individual drug properties like absorption, metabolism and toxicity risks.
This document provides an overview of malaria, including its causes, signs and symptoms, epidemiology, and types. Malaria is caused by Plasmodium parasites transmitted via mosquito bites. It most commonly affects children under 15 in tropical regions. Symptoms include fever, headache, and potentially severe complications like cerebral malaria. There are four main types that cause disease in humans, with P. falciparum being the most severe. Prevention relies on reducing mosquito habitats and bites through measures like insecticides and bed nets.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. Limb length measurement aims to
measure length of individual limbs
(usually lower limbs) with the help of inch
tape.
In clinical practice, exact length of each
lower limb is relatively unimportant, but
important is the difference in length which
exists between the two lower limbs.
3. Differences between the lengths of the upper
and/or lower arms and the upper and/or lower
legs are called limb length discrepancies
(LLD).
Except in extreme cases, arm length differences
cause little or no problem in how the arms
function.
4. Incidence
A limb length difference may simply be a mild variation
between the two sides of the body.
This is not unusual in the general population.
For example, one study reported that 32 percent of 600
military recruits had a 1/5 inch to a 3/5 inch difference
between the lengths of their legs. This is a normal variation.
Greater differences may need treatment because a
significant difference can affect a patient's well-being and
quality of life.
5. Classification of leg length discrepancy (LLD):
Structural (SLLD) or anatomical or true : Differences in
leg length resulting from inequalities in bony structure.
Functional (FLLD) or apparent: Unilateral asymmetry of
the lower extremity without any concomitant shortening of
the osseous components of the lower limb.
6. Etiological factors :
• Idiopathic developmental abnormalities
• Fracture
• Trauma to the epiphysis ( endplate ) prior to skeletal
maturity
• Degenerative disorders
• Legg-calvé- Perthes disease
• Cancer or neoplastic changes
• Infections
• Functional:
o Shortening of soft tissues
o Joint contractures
o Ligamentous laxity
o Axial malalignments
o Foot biomechanics (such as excessive ankle
7. Legg-Calvé-Perthes disease (LCPD) is avascular
necrosis of the proximal femoral head resulting from
compromise of the tenuous(weak) blood supply to this
area. LCPD usually occurs in children aged 4-10 years.
The disease has an insidious onset and may occur after an
injury to the hip
8. Causes
A. Previous Injury to a Bone in the Leg or
Growth plate injury :
1. Trauma (fracture)
2. Infection
1. Trauma
A broken leg bone may lead to a limb length
discrepancy if it heals in a shortened position.
This is more likely if the bone was broken in many
pieces.
It also is more likely if skin and muscle tissue
around the bone were severely injured and exposed,
as in an open fracture.
9. Broken bones in children sometimes grow faster for several
years after healing, causing the injured bone to become longer.
A break in a child's bone through the growth center near the
end of the bone may cause slower growth, resulting in a
shorter leg.
10. 2. Bone Infection:
Bone infections that occur in children while they are
growing may cause a significant limb length discrepancy.
This is especially true if the infection happens in infancy.
Inflammation of joints during growth may cause unequal
leg length. One example is juvenile arthritis.
11. B. Bone Diseases (Dysplasias) :
Bone diseases may cause limb length discrepancy, as
well.
C. Neurologic conditions
Asymmetric paralysis
1. Poliomyelitis
2. Cerebral palsy
3. Hemiplegia
D. Mass induced growth
1. Tumor
2. Post-fracture hyper-vascularity
3. Neurofibromatosis
12. Fibrous dysplasia:
Scar-like (fibrous) tissue
develops in place of
normal bone. As the bone
grows, the softer, fibrous
tissue expands, causes
weakening the bone.
Fibrous dysplasia can
cause the affected bone to
deform and become
susceptible to fracture.
16. E. Idiopathic
Unilateral Hemi hypertrophy (one side too big)
or hemi atrophy (one side too small) are rare
limb length discrepancy conditions.
In these conditions, the arm and leg on one
side of the body are either longer or shorter
than the arm and leg on the other side of the
body.
There may also be a difference between the two
sides of the face. Sometimes no cause can be
found. This is known as an "idiopathic"
difference.
F. Long femoral component after total
hip replacement
17. • Anatomical deformities:
1. Coxa vara or coxa valga
2. Genu varum or genu valgum
3. Congenital or acquired dislocation of hip
4. Congenital talipus equino varus
18. Sometimes the cause of limb length discrepancy is unknown,
particularly in cases involving under development of the inner or
outer side of the leg, or partial overgrowth of one side of the body.
These conditions are usually present at birth, but the leg length
difference may be too small to be detected.
19. As the child grows, the limb length discrepancy
increases and becomes more noticeable.
In underdevelopment, one of the two bones tibia and
fibula is abnormally short.
There also may be related foot or knee problems.
20. Associated problems :
Inequality in leg length is commonly associated with
compensatory gait abnormalities and may lead to
degenerative arthritis of the lower extremity and lumbar
spine.
21. Patients with leg-length discrepancy (LLD) can also have
angular and torsional deformities as well as soft tissue
contractures of the ipsilateral or contralateral extremity
that may influence their functional leg lengths.
For instance, flexion contractures around the knee and hip
can cause apparent shortening of the leg, while abduction
contractures of the hip and equinus deformity of the ankle
tend to functionally lengthen the affected extremity.
22.
23. Examination
The most accurate method to identify leg (limb) length
inequality (discrepancy) is through radiography.
Radiography: Limitations are an inherent inaccuracy in
patients with hip or knee flexion contracture.
However, radiography has to be performed by a
specialist, takes more time and is costly. It should only
be used when accuracy is critical.
25. Scan method ( x-ray)
Not available without professional medical
equipment. This methods involves scanning the pelvis
and legs and with the use of computer technology, the
images are enlarged to measure the distance
between reference points (again, usually the pelvis
and ankle joints), with very high accuracy.
26.
27. Some health professionals stress that the more
traditional methods of measuring such as the
apparent and true methods are accurate enough
without the need for a scan, which is expensive and
time consuming and can even expose you to
unnecessary radiation.
It is therefore recommended that people try the
easier and harmless methods first as clinical
evidence suggests these are highly accurate when
carried out correctly.
28. Direct methods:
Measuring limb length with a tape measure between 2
defined points. If you choose for this method, keep
following possible errors in mind:
• Always use the mean of at least 2 or 3 measures
• If possible, compare measures between 2 or more
clinicians
• Iliac asymmetries may mask or accentuate a limb length
inequality
• Unilateral deviations in the long axis of the lower limb (eg.
Genu varum,…) may mask or accentuate a limb length
29. Indirect methods:
Palpation of bony landmarks, most commonly the iliac
crests or anterior superior iliac spines, in stand. These
methods consist in detecting if bony landmarks are at
(horizontal) level or if limb length inequality is present.
Palpation and visual estimation of the iliac crest (or
ASIS) in combination with the use of blocks or book
pages of known thickness ,under the shorter limb to
adjust the level of the iliac crests (or ASIS), appears to
be the best (most accurate and precise) clinical method
31. TRUE LIMB LENGTH MEASUREMENT
True length is the measurement of lower
limb to diagnose true shortening or true
discrepancy.
Present when there is a decrease in
distance between the upper surface of
head of femur & lower surface of
calcaneum when compared on both the
32. For clinical purpose, two fixed bony points are taken
for reference;
ASIS (anterior superior iliac spine) because
it lies proximal & lateral to upper surface of head of
femur
&
Medial malleolus (or lateral malleolus)
because its tip corresponds to calcaneum
33. Direct method
1. Position of patient – supine lying
Identify ASIS on both sides & draw an imaginary line
connecting both.
Prior to measuring, place the normal limb in a similar position
to that of affected limb (squaring of pelvis).
Place one end of the inch tape over ASIS of affected side &
take the tape through the thigh till medial border of patella &
then along the medial border of leg till the tip of medial
malleolus.
Note the reading of tape & repeat for other limb.
Compare reading & note if there is any difference in
measurements
The difference indicates shortening.
34. The medial malleolus should present no problem as
it is easily palpated subcutaneously but the ASIS can
sometimes be difficult to palpate in obese patients.
It is easy to introduce an error of a cm or so in leg
length measurements if you do not measure from
equivalent positions bilaterally.
35. Squaring of pelvis
It is a technique to place lower limbs
in such a position that both ASIS are at
same level and in a straight horizontal
line.
36. Adduction or Abduction deformity:
If both ASIS are at the same level and the pelvis is square
there is no adduction or abduction deformity.
If the ASIS on the affected side is higher, an adduction
deformity is present.
Similarly if the ASIS on the affected side is lower than the
normal side, an abduction deformity is present.
37. An abduction contracture of the hip causes a functional leg
length difference.
The pelvis dips towards the affected side, the normal leg
appears shortened and the affected leg lengthened.
The opposite occurs with an adduction deformity.
The affected leg appears shortened and the patient attempts
to compensate with elevating the ASIS on the affected side
to bring his or her legs into parallel alignment.
38. Flexion contracture of the knee
Unable to place the legs straight because of the fixed
flexion of the knee. You must place the other leg in the
same position. One could flex the unaffected knee over a
bolster to the same degree and then measure leg lengths
Valgus knee -
Measure component parts of the leg.
This approximates to a true leg length
Measure from the ASIS to the tibial tuberosity and then
from the tibial tuberosity to the medial malleolus.
39.
40.
41. Indirect method
Procedure of the indirect measurement method: the use of
blocks :
Position of patient – standing with both knees fully extended
with feet 10 cm apart and equal weight on both feet.
The clinician places his/her hands on a bilateral anatomical
structure: posterior superior iliac spine, anterior superior iliac
spine or iliac crest on left and right.
Identify ASIS on both sides; ASIS on the side of shortened
limb will be at lower level.
42. Now the clinician visually assesses if there is a length
inequality, and if so, Place wooden blocks of varying
thickness under the foot of shortened limb until both the
ASIS are at the same level and equal length is reached.
Total height of wooden blocks equals the difference
in length.
Variables reported by literature are: pelvic asymmetry,
incorrect positioning of feet, obesity, joint contractures,
scoliosis and inaccurate measurement.
43.
44. After measuring the true length, if there is any
shortening, it is now to find out the site of
shortening – whether it is supratrochanteric
or infratrochanteric.
45. SUPRATROCHANTERIC
MEASUREMENT
Here the shortening is above greater
trochanter.
Causes to supratrochanteric shortening
are-
1. Coxa vara or coxa valga
2. Congenital or acquired hip dislocation
3. Fracture neck femur
4. Hip arthritis
53. 1. BRYANT’S TRIANGLE
This triangle is constructed on both sides as follows;
Line 1 – Drawn from ASIS to greater trochanter.
Line 2 – Imaginary line drawn from ASIS to couch
perpendicularly
Line 3 – horizontal line drawn from greater
trochanter to line 2 above
Measure & compare with other side.
54. Identify the ASIS with your thumb and the tip of the
greater trochanter with your main finger and the base of
the triangle with your index finger.
55.
56.
57. Bryant’s triangle is drawn on both sides & length of line is
measured & compared.
Difference in length of 3rd line indicates the upward shift of
trochanter & confirms supratrochanteric shortening.
Difference in length of 1st & 2nd line indicates anterior or
posterior shift of greater trochanter.
This test is not useful in bilateral hip disease.
58. Causes :
Shortening above the trochanter may be caused by -
- Destruction of the femoral head or acetabulum or both
- Dislocated hip
- Coxa -vara deformity
- Mal -united inter-trochanteric fracture.
59. 2. SHOEMAKER’S LINE
Supine position:
Line joined by connecting two points greater trochanter & ASIS
when extended up on both sides
1. May cross above the umbilicus in the midline – Normal
2. May cross below the umbilicus away from midline – opposite
unilateral supratrochanteric shortening
3. May cross in midline below the umbilicus – bilateral
supratrochanteric shortening
Not useful in case of bilateral disease.
60.
61. 3. CHIENE’S LINE
Supine position:
The lines joining two ASIS & two greater
trochanter are usually parallel.
This is disturbed if one of the greater
trochanter is shifted upwards.
Useful in unilateral disease only.
62. 4. NELATON’S LINE
In supine lying, when a line is drawn from ischial
tuberosity to the ASIS, the greater trochanter just
touches this line.
If greater trochanter is above the line then
supratrochanteric shortening is confirmed.
Useful in unilateral as well as bilateral hip disease.
63.
64. The patient lies with the affected side uppermost.
With the hip flexed up at 90 the tip of the greater
trochanter should lie on or below a line
connecting the anterior superior iliac spine and
ischial tuberosity.
In cases of supra-trochanteric shortening, the
trochanter will be above to this line
65. INFRATROCHANTERIC
MEASUREMENT
Here shortening is below the greater trochanter.
The causes can be;
a. Mal-united fracture femur or tibia
b. Skeletal growth disturbances
c. Genu varum or Genu valgum
66. METHODS OF MEASUREMENT
GALLEZI’S (OR ALLEN’S) TEST
INDIVIDUAL BONE LENGTH or
segmental MEASUREMENT
67. GALLEAZI’S (or ALLEN’S) TEST
This test demonstrates whether the shortening is
in the femur or tibia
The patient is supine with the hips flexed to
45º and the knees flexed up to 90º.
Place the malleoli together(the test is inaccurate
if you are unable to do so).
68. The examiner assesses the position of both knees
from the end of the bed and from the side
In Case of femoral shortening, both thighs are at
level but the knee is slightly lower than normal one.
The leg is also slightly behind the normal leg.
In case of tibial shortening, both legs are at level
but thigh is not at level & knee appears forwards
69.
70.
71. 2. INDIVIDUAL BONE LENGTH
MEASUREMENT
Length of femur can be measured from
ASIS to the medial joint line of knee &
tibial measurement can be done from
medial joint line of knee to the medial
malleolus.
Measure on both sides & compare.
72. COMPLICATIONS DUE TO TRUE
DISCREPANCY
Compensatory scoliosis
Low back pain
Gait abnormalities with secondary injuries
Over stretching/contracture of muscles
73. APPARENT LIMB LENGTH
MEASUREMENT
Apparent measurement helps in assessing the extent
of natural compensation developed for concealing the
natural deformity/disparity.
Apparent limb length discrepancy (LLD) may be due to:
- Suprapelvic obliquity : Scoliosis
- Intrapelvic obliquity : Pelvic fracture
- Infrapelvic obliquity : Hip contracture
- Knee contracture
-Ankle contracture
74. METHOD OF MEASUREMENT
Position of patient – Supine lying.
Arrange the lower limbs parallel to each another; for
that bring the unaffected limb near to the affected limb &
align the trunk in line with the lower limbs. (Apparent
length is measured by positioning both the lower limbs
parallel to each other & without correcting any of the
existing deformities. In bilateral affections, apparent
measurement is not of much significance.)
75. With inch tape measure the distance between
xiphisternum (or umbilicus) to the tip of medial
malleolus & note the reading.
Repeat it for the other limb & if difference exists then it
indicates apparent discrepancy.
76. Shortening in one limb is usually compensated by --
- Tilting the pelvis down (ASIS dips at a lower level)
- Equinus position of the foot
- Flexing the opposite lower limb at the hip and knee
77. If the true shortening is equal to apparent shortening
it indicates there is no compensation.
If the true shortening is more than the apparent one it
indicates that part of the shortening has been
compensated for.
If the true shortening is less than the apparent
shortening it would suggest a fixed adduction
78. TREATMENT OF LIMB LENGTH
DISCREPANCY
0 – 2 cm: no treatment
Difference of less than 3cm are usually accepted by
the patients & can be corrected by shoe raise of the
shortened limb.
Difference in length between 4 to 15cm are corrected
by surgery; Surgical intervention
79. Epiphysiodesis of long leg (Epiphysiodesis is a
pediatric surgical procedure in which the epiphyseal
(growth) plate of a bone is fused either temporarily or
permanently to delay growth of a long bone. This
procedure is often used to slow or halt the growth of a
morphologically normal leg to allow a shorter leg to
grow to a matching length)
Long leg shortening or short leg lengthening
Any difference in length of more than 15cm are
usually difficult to be corrected by surgical methods
also.
83. References
Canale (1998) Campbell's Orthopaedics, Mosby,
p. 986
Hoppenfeld (1976) Spine and Extremities, p. 165
Review: Limb Length Inequality: Clinical
Implications for Assessment and Intervention
(2003) Rebecca J. Brady PT, John B. Dean
PT;ATC, T. Marc Skinner, PT;ATC, Michael T.
Gross, PT;PhD.Level of evidence: 1
Review: Leg Length Discrepancy (2001) – Burke
Gurney
Measurement of limb-length inequality.
Comparison of clinical methods with
84. Changes in Pain and Disability Secondary to Shoe Lift
Intervention in Subjects With Limb Length Inequality and
Chronic Low Back Pain - A Preliminary Report – Yvonne
M. Golightly et al (2007) – Journal of orthopedics and
sports physical therapy E.B. LEVEL (2)
Conservative Correction of Leg-lengts discrepancies of
10mm of less for the relief of chronic low back pain. –
Ruth Defrin, Sarit Ben Benyamin et al. (2005) Arch Phys
Med Rehabil. E.B. LEVEL (2)
Erector Spinae and Quadratus Lomborum Muscle
endurance tests and supine leg-length alignment
asymmetry: and observational study – Gary A. Knuston
and Edward Owens (OCT 2005) Journal of Manipulative
and Physiological Therapeutics. E.B. LEVEL (2)
The accuracy of the palpation meter (PALM) for
measuring pelvic crest difference and leg length
discrepancy. – Matthew R. Petrone, Jennifer Guin et al
(JUN 2003) – Journal Orthop Sports Phys Ther VOL 33
(n°6) E.B. LEVEL (2)