Download Fundamentals in P.T. 203 Leg Length Measurement, Measurement

Fundamentals in P.T. 203
Leg Length Measurement, Measurement of Crutches & Crutch Walking
First: A quick review of what we took for the midterm (yes it's coming in the final
exam!)
 Massage is used to treat:
1. Insomnia
2. Headache
3. Muscle spasm
 Goniometry is used to test range of motion
 Decreased range of motion may be caused from:
1. Stiffness if the joint
2. Immobility for a long time
3. Fractures
4. Inflammation/Swelling/Effusion
5. Arthritis
6. Decreased synovial fluid (DO NOT take an injection in the joint of there is pain, it
will cause the joint to be dry and therefore, more pain!)
 Muscle testing, why do we do it?! (shili yswi limitation fil muscle work wala function 3shan
e7na enchoof gowat-ha?):
1. Pain
2. Weakness due to pathology
3. Muscle atrophy
4. Nerve injury
5. Disuse atrophy (if u don't use the muscle for a long time, methel etha etnamon 3la
9oob wa7ed moda 6eweela)
6. Fracture will cause  pull and push on muscle (kel part of the bone ero7 fee
direction '3air 3an el thani)
Second: Special Measurements 1
 Discrepancy (in general)= Two limbs are not equal in length, and caused from:
- Child is born with this deficiency
- Gap fracture (big distance between the fractured bones)
 Tibial Length Discrepancy= Legs are not equal in length because of:
- Length of tibia differs in the two limbs
- Fractures in the hip bones
- Posterior dislocation of the hip joint
- The child is born with this deficiency
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- Gap fracture (big distance between the bones)  lengthens limb
 Gait= Manner in which we walk
 When there is "Tibial Length Discrepancy", abnormalities in gait will occur such as:
- Abduction gait (patient walks with one leg abducted  abducts and circumducts the
leg to walk!) because of weakness in gluteus medius + min and weakness of tibialis
anterior
- High stepping gait (patient will have to left up his leg in order to walk)
- Antalgic gate (patient needs a stick to walk "3akkaz y3ni")
 To test if there is femoral length discrepancy, two different tests are done:
A. True Length Discrepancy Measurement:
*
From ASIS (Anterior Superior Iliac Spine) to medial malleolus  most common
From ASIS (Anterior Superior Iliac Spine) to lateral malleolus
Note that the measurement will change if you are doing it to L/M malleolus
B. Apparent Leg Measurement:
From xyphoid process to medial malleolus of each limb
Some therapists (or school of thoughts) use the belly button rather than the xyphoid
process. However, it won't be accurate (presence of obesity or "krsha")
- This method is used when there is a fracture in the tibia/femur/hip bones
 It's not used if the patient suffers from scoliosis, or if there is a fracture in the
hip or lower spine
 Girth measurement (width of part of limb)
- Knee  starting position will be below pattela (on tibial tuberosity)
 Used to measure the width of an affected leg by swelling at the joint, or
muscle atrophy (signs of osteoarthritis)
 ^ measure the width on 5, 10, 15, and sometimes 20 cm above the
starting point
 ^ measure the width on 5, 10, 15 cm below the starting point
- Elbow  starting position will be on the olecranon process of the ulna
 ^ measure the width on 5, 10, 15 cm above the starting point
Meas. Could be
 ^ measure the width on 5, 10, 15 cm below the starting point
affected due to
swelling,
- Ankle  do a figure of (8) around the ankle joint
Make sure the meas.
sprained
Tape is v. firm
- Wrist  do a figure of (8) around the wrist joint
-
ligament
Third: Clinical Features = Signs and symptoms
Signs  Symptoms  Diagnosis
 Signs (things you can see), such as:
1. Redness
2. Swelling
3. Atrophy
4. Bleeding
5. Decrease range of motion
6. Skin condition (e.g. eczema)
7. Infected skin (e.g. open wounds, puss)
8. Non-verbal signs:
a. Alert
b. Oriented
c. Motivated
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d. Pain (Facial expressions)
e. Anxious
 Symptoms (things you can feel), such as:
1. Pain
2. Burning sensation (nerve impairment)
3. Sharp pain
4. Difficulty in movement
 Diagnosis (know what's the problem), such as:
1. Fracture
2. Osteoarthritis
3. Rheumatoid arthritis
 Examples of diseases or syndromes regarding PT:
1.
Prepattella bursitis (wt's known as Clergyman syndrome or housemaid syndrome)
caused from long time sitting on the knee joint  cause inflammation of knee joint
2.
Baker's cyst  swelling in posterior aspect of the knee
3.
Pitting edema: if it occur in ankle, it could be a sign cardiac problems
4.
Osgood-schlatter: syndrome/disease  bone inflamed at site of insertion of patellar
tendon
Fourth: Crutch Gait (Axillary Crutches)
 Measurements: Anterior axillary fold to heel, with a radius of 15" out.
 Before giving the patient the crutches, check the following:
1. Adjust to patient’s height
2. Check that the crutches are in a good state and can be used
3. Rubber at the end
4. Screws are located and not loose
5. Teach the patient how to use them.
 Elbow joint should be flexed approximately 15
 Bottom of crutches should be away from heel of foot 15" (35 cm).
* Note: Long crutches may cause severe damage to the brachial plexus (cause paralysis of upper
limb), so be aware of that!
 Important terms:
o Swing to gait: move the leg until it becomes in level with the crutches (final position
will be: unaffected leg in line with the crutches)
o Swing through gait: move the leg until it exceeds the crutches (final position will be:
crutches behind unaffected leg)
Batch of 2004
Ba7raini [[email protected]] & Sharifa
[These notes are not related to or funded by any student parties of Kuwait University as well as any outside parties in any way.
It is an independent entity of its own and is supported by the doctors of KU]
Fundamentals in P.T. 203
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for more information