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Kooyman-Short leg syndrome lc26
Lecture 26
10
Medical
Graduate
12/07/2011

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Cards

Term
What is "short leg syndrome"?
Definition
  •  MISNOMER
  • May be unrelated to leg length. have multiple sx and finding: sacral-base unleveling, innominate rotation (compensatory), caudal side-bending away from side of low sacral base, most often.
  • DX and TX: treat all possible before sending them to radiological evaluation.
  • Radiology: measure coronal values of iliac crest heights, femoral head heights, sacral base unleveling, compensatory scoliotic curves (type, location, degree)
  • Remember: 2mm human error=25% bony distortion.
Term
[image]
Definition
  • left image: C-scoliotic response- convexity toward the short leg.
  • Right Image:  S-scoliotic response
Term

What's true discrepancy?

What's apparent discrepancy?

Definition
  • True Discrepancy: check fixed point (ASIS to med. malleolus/ femur and tibia).
  • Appearent discrepancy: nonfixed pt to fixed pt. (establish no true discrepancy exit first-check for pelvic torsion)
Term
what are the special test for pelvis dysfunction?
Definition
  • Trendelenburg-gluteus medius weakness
  • straight leg raising-lumbar radiculopathy
  • stinchfiled-intra-articular hip pathology
  • FABERE/Patrick's tesT: flexion, abduction, external rotation, extension. Hip, SI joint pathology.
  • Fadir/Fair: flexion, adduction, internal rotation, piriformis, hip
  • Thomas: iliopsoas contraction
  • Erichsen's tesT: SI and early spondylitic arthritis
  • Ober's tesT: contracture of ITB
  • Hip drop: assess lumbar involvement.

 

Term
What are the TX for "short-leg syndrome"
Definition
  • Heel Lift Therapy
  • OMT is done first
  • Heel lift is added to the heel on the side of lower sacral base. This is the process of reeducating the patient's whole body.
  • ex: right leg short, left leg long--> the body will side bend toward the left to compensate.
Term
What's the formular to derive at an appropriate heel height?
Definition

David Heilig's formula: L< [SBU] / [D + C]

 

§Duration (D)
1 = 0-10 years
2 = 10-30 years
3 = 30+ years
§Compensation (C)
0 = none observed
1 = sidebending and rotation
2 = wedging, facet size changes, endplates with horizontal growths, spurring
§Sacral Base Unleveling (SBU)
§Lift Required (L)
Term

sample heilig formula calculation:

Patient age 35, injured in early youth, minimal compensation

Definition

SBU= 1/2

Duration is -2 (35-10=25yrs)

Compensation= minimal (-1)

 

L= (1/2)/(2+1)= (1/2)/(3)= 1/6"

Term

Dx and evaluation of short leg syndrome.

What should the lift obtain?

what is the maximum lift in side and outside a shoe?

Definition
  • should obtain a negative standing flexion test, hence no more dysfunction.
  • maximum lift inside the shoe is 1/4 inches
  • maximum of 1/2 in between patient's heel and the floor. variable placement of the lift is possible.
  • When the heel is lifted too high, rotation may occured, add to the anterior portion of the shoe also to prevent rotation.
Term
What are other effects observed with a lift?
Definition
  • compressive forces can cause a bone to grow faster, esp in growing children. need to monitor heel lift tx in children carefully.
  • anterior lift therapy: affects pelvic roation to the same side as the lift.
  • overal goal-reeducate patient towards an ideal posture.
Term
What are the treatment of "short leg syndrome" (in a peanut shell!)
Definition
  • OMT: relax and stretch muscles, correct somatic dysfunction, increase mobility
  • Exercise: to stretch and tone
  • Lift therapy: based on sacral base unleveling, length of time present, amount of compensation.
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