Flashcards in 05-03: Limb Length, Girth and Volume Deck (25):
1
Importance of height and weight
- Pt with disorders that may result in abnormal fluid retention
- Determining BMI for overweight/obese categories
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Disorders with abnormal fluid retention (5)
- Diabetes
- Edema
- Lymphedema
- Venous disease
- Underlying cardiopulmonary disease
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Standing LLD (Appearance)
One LE appears longer than other, or 1 side of pelvis is elevated
4
Supine LLD (Appearance)
One LE appears longer than other
- Patella not aligned
- Malleoli not aligned
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Lift and level pelvis
One LE appears longer
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Assessing limb length - standing
Pelvis level (ASIS, PSIS, Iliac Crest)
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Assessing limb length - supine
Measure (Compare both limbs, identify which is longer/shorter in relation to the other)
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Measuring apparent LLD
- Pt supine (hips flexed, knees flexed, back)
- Measure umbilicus to medial mallelolus (inferior, most distal part of malleolus)
- Compare one side to other (if pt measured previously, measure both again to compare with previous)
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What can alter apparent LLD measurement
- Position of foot,
- Atrophy
- Body mass
- Pelvic obiquity
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Causes of apparent LLD
- Pelvic obiquity (ASIS and/or PSIS not level)
- Hip adduction deformity (Increased tone can drop pelvis a little bit)
- HIp flexion deformity (may appear shorter because of limb shortening
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Measuring True LLD
- Pt supine (hips flexed, knees flexed, back)
- Measure ASIS (just inferior to ASIS) to medial mallelolus (bony prominence to bony prominence)
- Compare one side to other (if pt measured previously, measure both again to compare with previous)
*European - ASIS to lateral malleolus (thigh mass may interfere during measurement to lateral malleolus
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Real leg length
- True leg length
- ASIS to distal medial malleolus
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Determining location of LLD
- Pt supine, both knees flexed 90˚, feet flat
- one knee higher = longer tibia
- one knee projects further distally = longer femur
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LLD Correction
- If difference more than 1/2 inch (1 cm), compensate by placing shoe lift in pt shoe
- If pt has weakness and difficulty with swing through, shoe lift in contralateral side (short term(
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Reasons for limb girth measurements (3)
- Atrophy
- Hypertrophy
- Edema
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Measuring limb girth
- Use tape measure specifically designed for measuring circumference of limb
- Measure in reference to bony landmarks (specify location, repeat measurements using same landmarks when re-assessing limb girth)
- Measure in consistent increments (multiple, the smaller the increments, the better representation)
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Measuring Edema
- Girth measurements
- Pitting (Depth of pitting, time of refilling)
- Staging
- Grading
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Staging Edema (Stage I)
- Reversible edema
- Elevation to reduce swelling
- Pits on pressure
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Staging Edema (Stage II)
- Spontaneously irreversible lymphedema (fibrous)
- Minimal pitting even with moderate swelling
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Staging Edema (Stage III)
- Lymphostatic elephantiasis (large limbs)
- Appearance of skin is elephant-like (bumps, skin changes consistency)
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Grading Edema (all occurs within 30 sec window)
1+ = Indentation is barely detectable
2+ = Slight indentation visible when skin is depressed, returns to normal in 15 sec
3+ = Deeper indentation occurs when pressed and returns to normal within 30 sec
4+ = Indentation lasts for more than 30 sec
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Interventions for Edema (3)
- Cryotherapy
- Compression
- Elevation
23
Archimede's Principle
Water volume displaced is equal to the volume of the object immersed in the water
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Volumeter
Device used to measure volumes of liquids by the amount they displace
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