Flashcards in Short Leg Syndrome Deck (57):
What is short leg syndrome?
A collection of compensatory changes that occurs when there is sacral base unleveling
Where in the spine does short leg syndrome manifest?
Lumbar and sacral regions
What are the dirty half-dozen?
1. Nonneutral dysfunction in the lumbar spine
2. Dysfunction of the pubis
3. Sacral dysfunction
4. Up or down slips
5. Muscle imbalance
6. Short leg syndrome
What is the presentation of short leg syndrome?
Patient will stand and walk differently, eventually resulting in the patient seeking help for pain/ROM
What is the functional short leg?
-Sacral base unleveling d/t SDs that cause one leg to appear shorter than the other
-No true leg measurement difference
What is the anatomic cause of short leg syndrome?
Leg length discrepancy between the left and right lower limbs
Which is more common:anatomic or functional causes of short leg syndrome?
How do you diagnose a small hemipelvis?
Higher iliac crest on one side relative to the ITs when sitting
What is the compensatory mechanism for a small hemipelvis?
What is the treatment for a small hemipelvis?
Apply IT support
What are the dysfunctions that can cause a functional short leg syndrome?
What muscle contractions can cause a functional short leg syndrome? (2)
-Contraction of psoas
What are the anatomic causes of short leg syndrome?
What is the compensation that occurs at the lumbar spine with short leg syndrome?
Scoliosis with convexity on the side of the short leg
What is the compensation that occurs at the innominates with short leg syndrome?
Anterior rotation on the side of the short leg
What is the compensation that occurs at the foot with short leg syndrome?
Pronation on the side of the long leg
What is the compensation that occurs at the hips with short leg syndrome?
Increased stress on side of long leg: may predispose patient to DJD
What is the compensation that occurs at the paravertebral muscles with short leg syndrome?
Muscles on the side of the convexity are stretched
Muscles on the side of the concavity are shortened
What is the compensation that occurs at the iliolumbar ligaments with short leg syndrome?
Stretched on the side of the short leg (side of the convexity)--this stress can cause a referral of pain to the ipsilateral groin region
What is the compensation that occurs at the SI ligament with short leg syndrome?
Can be stressed on both sides. However, the long leg side is more commonly symptomatic
What happens to shoulder height with short leg syndrome?
Higher on side of the short leg
What is the most common presentation of short leg syndrome?
-Pant leg seems longer
-Unilateral dropped arch
Why is taking account of the duration of the pain with short leg syndrome important?
Congential vs acquired (e.g. surgery)
What are the SDs that can cause short leg syndrome? (3)
What may be found on PE with SLS?
-LROM of the back
What are the structural findings that can be found with SLS, when standing? (2)
Low or high:
-Greater trochanter heights
How can you differentiate SLS vs small hemipelvis?
Prone, the spine should be straight, and there should be no leg length discrepancy
How many attempts at OMT should be done prior to diagnosing SLS?
What are the three major goals of treating SLS?
Max balance of:
-Musculature affecting the pelvis
If leg lengths even out following treatment of upslip, is is more likely functional or anatomic?
What happens after the treatment of an apparent upslip, when it is actually a true anatomic SLS?
Leg discrepancy gets worse
What happens to the medial malleoli lengths after treatment of on an upslip, if the issue is an anatomic vs functional SLS?
Anatomic = Worse discrepancy
Functional = even out
When should you evaluate the sacrum for SLS: before or after treatment of innominate shears?
After innominate shears have been corrected
What area needs to be dysfunction-free before diagnosing SLS?
What are the muscles that should be evaluated for imbalances with SLS?
-Hip flexors, hamstrings, adductors
If the SDs of the QL correct well with suspected SLS, what areas should be evaluated next? What if these areas are improved?
Functional cause of SLS
If treatment of the QL does not balance out the standing landmarks, what should be suspected?
Tight QL--trigger pt injection
-May be anatomic dysfunction
What is the treatment for true anatomic causes of SLS?
-Heel lift therapy
What are the three landmarks that should be inspected when prone to evaluate for SLS?
-Iliac crest heights
How can you determine if treating SDs is sufficient for treating SLS AFTER treatment?
If the standing flexion test is still positive with normal standing, but is negative with heel lift support
What are the two ways to evaluate if a heel lift is an appropriate height?
Clinically or radiologically
What is the major indication for heel lift therapy?
If there is no improvement with OMT
What should be assessed for in the foot prior to starting a heel lift orthotic?
Under how many mm is a sacral base unleveling tolerable?
What are the three factors that should be taken into consideration when assessing the need for heel lift?
-How bad sacral base unleveling
-Length of time present
-Amount of compensation
What is the inter and intrarater reliability of x-ray evaluation of SLS?
What is the radiograph that is obtained to evaluate for SLS?
Single AP projection of lumbar spine and pelvis
What is the indication to start with a smaller heel lift?
If the issue is chronic (has compensatory changes)
True or false: a heel lift has to be used every time the patient walks
If the SBU is measured in *degrees*, how do you determine how much heel lift will be needed?
1/8th of an inch for every degree of sacral base unleveling
If the SBU is measured in *length*, how do you determine how much heel lift will be needed?
if 2 mm of sacral base declination, add 2 mm to heel lift
What is the maximum amount of heel lift that can be added inside the shoe?
If the patient needs more than 1/4 inch of a heel lift, how should the additional lift be distributed? What should be done if there is still a need for more lift?
1/4 inch outside, 1/4 inside
After this, add 1/2 of total lift to the sole
What is the Heilig formula?
L = [SBU]/[D+C]
What are the values of D (duration) in the Heilig formula?
1 = 0-10 years
2 = 10-30 years
3 = 30+ years
What are 0, 1, and 2 values for C in the Heilg formula (compensation)?
0 = none
1 = rotations of lumbars into convexity
2. Wedging of the vertebrae, spurring