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Clinical Reasoning Typical cases are discussed there. The cases are brought by practioners.

 
 
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Old 14-06-2008, 02:42 PM   #1
marcel
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Default "Sudden" discrepancy in lower limb length

Hi,

I ask you for some input (thoughts) here.

Last week I saw a 65 yr old woman, reffered for arthrosis in knees and hips. Major complains are pain lower back and in both knees.
Remarkably in her story is her question : she noticed a relative shortening of her right leg which had to occur within a timeframe of one year; next to this she mentions to fall at least 3 times a year always landing on a knee, she never had severe pelvic or backpain after a fall.
X-rays of both hips and knees show mild arthrosis. In testing her right leg seems to be at least 1,5 cm shorter. A bit difficult to test due to obesitas is the orientation of SIAS and SIPS however it does show an indication of pelvic torsion where the left ilium is in relative anteversion opposed to the right wich is in retroversion. (i.e tilted forwards & backwards)
I consulted the reffering orthopedist about his findings if that might explain the relative "sudden" discrepancy in lower limb length.
He mentioned a slight valgus change of the "longer" leg and a torsion in the pelvis, but no opinion if that could explain this discrepancy in lower limb length.

Has anyone seen something similar before? Where a patient mentions a discrepancy in lower limb length that became noticable in a relative short period of time.

I appreciate your input.
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