Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
There are two main types of leg length inequalities:
- Structural differences are caused by the legs themselves being measurably different in length, usually due to differences in the length of the femur in the thigh or the tibia and fibula bones in the lower leg. This may be a birth defect or it may occur after a broken leg, serious infection, or local damage to one of the growth plates in a leg.
- The other, more common, type is seen when the legs themselves are the same length, but due to neuromuscular injuries in the pelvis or upper leg, one leg or hip is held higher and tighter than the other (hypertonicity in the musculature of the pelvis or leg). These unequally tightened muscles cause the legs to seem to be different lengths, even though careful measurement would show equal lengths of the actual leg. This is called leg length alignment asymmetry (LLAA) and can be seen while lying down.
Unequal leg length (also termed leg length inequality, LLI or leg length discrepancy, LLD) is where the legs are either different lengths or appear to be different lengths because of misalignment.
In some cases, an audible snapping or popping noise as the tendon at the hip flexor crease moves from flexion (knee toward waist) to extension (knee down and hip joint straightened). After extended exercise pain or discomfort may be present caused by inflammation of the iliopsoas bursae. Pain often decreases with rest and diminished activity. Symptoms usually last months or years without treatment and can be very painful.
Bowing of one or both legs that may:
- Be rapidly progressive
- Appear asymmetric
- Primarily occur just below the knee
ITBS symptoms range from a stinging sensation just above the knee joint, to swelling or thickening of the tissue in the area where the band moves over the femur. The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. Pain may not occur immediately during activity, but may intensify over time. Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia. It will also hurt if you twist your knee to turn a corner.
Failure to treat Blount's disease may lead to progressive deformity.Blount's disease may come back after surgery, especially in younger children. Because of the bowing, a leg-length discrepancy may result. This may result in disability if the discrepancy is significant (greater than 1 inch) and is not treated.
Snapping hip syndrome (also referred to as coxa saltans, iliopsoas tendinitis, or dancer's hip) is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by an audible snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is classified by location of the snapping, either or articular.
Iliotibial band syndrome (ITBS) is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting (especially squats).
Cancers including acute lymphocytic leukemia, osteosarcoma, and Ewing’s sarcoma may result in a gradual onset of limping in children. It is often associated with night sweating, easy bruising, weight loss, and pain most prominent at night.
Legg–Calvé–Perthes syndrome is a degenerative disease of the head of the femur which results in bone loss and deformity. It usually presents as a chronic condition.
The primary symptom is hip pain, especially hip pain on the outer (lateral) side of the joint. This pain may appear when the affected person is walking or lying down on that side.
Greater trochanteric pain syndrome (GTPS), also known as trochanteric bursitis, is inflammation of the trochanteric bursa, a part of the hip.
This bursa is at the top, outer side of the femur, between the insertion of the gluteus medius and gluteus minimus muscles into the greater trochanter of the femur and the femoral shaft. It has the function, in common with other bursae, of working as a shock absorber and as a lubricant for the movement of the muscles adjacent to it.
Occasionally, this bursa can become inflamed and clinically painful and tender. This condition can be a manifestation of an injury (often resulting from a twisting motion or from overuse), but sometimes arises for no obviously definable cause. The symptoms are pain in the hip region on walking, and tenderness over the upper part of the femur, which may result in the inability to lie in comfort on the affected side.
More often the lateral hip pain is caused by disease of the gluteal tendons that secondarily inflames the bursa. This is most common in middle-aged women and is associated with a chronic and debilitating pain which does not respond to conservative treatment. Other causes of trochanteric bursitis include uneven leg length, iliotibial band syndrome, and weakness of the hip abductor muscles.
Greater trochanteric pain syndrome can remain incorrectly diagnosed for years, because it shares the same pattern of pain with many other musculoskeletal conditions. Thus people with this condition may be labeled malingerers, or may undergo many ineffective treatments due to misdiagnosis. It may also coexist with low back pain, arthritis, and obesity.
Lameness is most commonly caused by pain, but may also be the result of neuromuscular disease or mechanical restriction. Lameness itself is a clinical sign, and not a diagnosis.
A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear' called a degenerative tear.
Tears can lead to pain and/or swelling of the knee joint. Especially acute injuries (typically in younger, more active patients) can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the knee joint. The joint will be in pain when in use, but when there is no load, the pain goes away.
A tear of the medial meniscus can occur as part of the unhappy triad, together with a tear of the anterior cruciate ligament and medial collateral ligament.
Proximal femoral focal deficiency (PFFD), also known as Congenital Femoral Deficiency (CFD), is a rare, non-hereditary birth defect that affects the pelvis, particularly the hip bone, and the proximal femur. The disorder may affect one side or both, with the hip being deformed and the leg shortened.
It is commonly linked with the absence or shortening of a leg bone (fibular hemimelia) and the absence of a kneecap. Other linked birth defects include the dislocation or instability of the joint between the femur and the kneecap, a shortened tibia or fibula, and foot deformities.
Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened, and the development of a limp. It is commonly caused by injury, such as a fracture. It can also occur when the bone tissue in the neck of the femur is softer than normal, causing it to bend under the weight of the body. This may either be congenital or the result of a bone disorder. The most common cause of coxa vara is either congenital or developmental. Other common causes include metabolic bone diseases (e.g. Paget's disease of bone), post-Perthes deformity, osteomyelitis, and post traumatic (due to improper healing of a fracture between the greater and lesser trochanter). Shepherd's Crook deformity is a severe form of coxa vara where the proximal femur is severely deformed with a reduction in the neck shaft angle beyond 90 degrees. It is most commonly a sequela of osteogenesis imperfecta, Pagets disease, osteomyelitis, tumour and tumour-like conditions (e.g. fibrous dysplasia).
Coxa vara can happen in cleidocranial dysostosis.
In an anterior dislocation the limb is held by the patient in externally rotated with mild flexion and abduction. Femoral nerve palsies can be present, but are uncommon.
Trendelenburg's sign is found in people with weak or paralyzed abductor muscles of the hip, namely gluteus medius and gluteus minimus. It is named after the German surgeon Friedrich Trendelenburg.
The gluteus medius is very important during the stance phase of the gait cycle to maintain both hips at the same level. Moreover, one leg stance accounts for about 60% of the gait cycle. Furthermore, during the stance phase of the gait cycle, there is approximately three times the body weight transmitted to the hip joint. The hip abductors' action accounts for two thirds of that body weight. The Trendelenburg sign is said to be positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg to reduce the load by decreasing the lever arm. By reducing the lever arm, this decreases the work load on the hip abductors. The muscle weakness is present on the side of the stance leg. A Trendelenburg sign can occur when there is presence of a muscular dysfunction (weakness of the gluteus medius or minimus) or when someone is experiencing pain. The body is not able to maintain the center of gravity on the side of the stance leg. Normally, the body shifts the weight to the stance leg, allowing the shift of the center of gravity and consequently stabilizing or balancing the body. However, in this scenario, when the patient/person lifts the opposing leg, the shift is not created and the patient/person cannot maintain balance leading to instability.
Nine out of ten hip dislocations are posterior. The affected limb will be in a position of flexion, adduction, and internally rotated in this case. The knee and the foot will be in towards the middle of the body. A sciatic nerve palsy is present in 8%-20% of cases.
Attenuated patella alta is an extremely rare condition affecting mobility and leg strength. It is characterized by an unusually small knee cap (patella) that develops out of and above the joint. Normally, as the knee cap sits in the joint, it is stimulated to growth by abrasion from the opposing bones. When not situated properly in the joint, the knee cap does not experience such stimulation and remains small and undeveloped. Note that the cartilage under and around the kneecap is eight times smoother than ice, so "abrasion" may not be the best term.
A similar condition, patella alta, can occur as the result of a sports injury, though the large majority of the time it is a congenital/developmental condition that is unrelated to trauma. A kneecap in an "alta" position sits above the "trochlear groove" and therefore is less stable. The "patellar tendon" that connects the kneecap to the tibia (shinbone)is elongated (longer than normal). This cannot happen by way of trauma, unless there has been a rupture of the tendon and a less-than-optimal surgical repair.
There has been only one documented case of the disorder noted from birth. In 1988, three-year-old Eric Rogstad of Minneapolis, Minnesota was discovered to suffer from the condition in both knees after several attempts by his parents and family physician to discover the cause of his abnormal difficulties with walking and running. After surgery and physical therapy, Eric gained the ability to walk and run without significant difficulty.
Insall Ratio: This ratio is calculated with the knee flexed to 30 degrees. It is the ratio of the length of the patella to the length of the patellar tendon. Normally this ratio is 1:1 but 20% variation represents patella alta or patella infera. Actually, the Insall-Salvati ratio can be measured at any degree of flexion, which is one reason for its popularity.
A combination of postural changes, the growing baby, unstable pelvic joints under the influence of pregnancy hormones, and changes in the centre of gravity can all add to the varying degrees of pain or discomfort. In some cases it can come on suddenly or following a fall, sudden abduction of the thighs (opening too wide too quickly) or an action that has strained the joint.
PGP can begin as early as the first trimester of pregnancy. Pain is usually felt low down over the symphyseal joint, and this area may be extremely tender to the touch. Pain may also be felt in the hips, groin and lower abdomen and can radiate down the inner thighs. Women suffering from PGP may begin to waddle or shuffle, and may be aware of an audible clicking sound coming from the pelvis. PGP can develop slowly during pregnancy, gradually gaining in severity as the pregnancy progresses.
During pregnancy and postpartum, the symphyseal gap can be felt moving or straining when walking, climbing stairs or turning over in bed; these activities can be difficult or even impossible. The pain may remain static, e.g., in one place such as the front of the pelvis, producing the feeling of having been kicked; in other cases it may start in one area and move to other areas. It is also possible that a woman may experience a combination of symptoms.
Any weight bearing activity has the potential of aggravating an already unstable pelvis, producing symptoms that may limit the ability of the woman to carry out many daily activities. She may experience pain involving movements such as dressing, getting in and out of the bath, rolling in bed, climbing the stairs or sexual activity. Pain may also be present when lifting, carrying, pushing or pulling.
The symptoms (and their severity) experienced by women with PGP vary, but include:
- Present swelling and/or inflammation over joint.
- Difficulty lifting leg.
- Pain pulling legs apart.
- Inability to stand on one leg.
- Inability to transfer weight through pelvis and legs.
- Pain in hips and/or restriction of hip movement.
- Transferred nerve pain down leg.
- Can be associated with bladder and/or bowel dysfunction.
- A feeling of the symphysis pubis giving way.
- Stooped back when standing.
- Malalignment of pelvic and/or back joints.
- Struggle to sit or stand.
- Pain may also radiate down the inner thighs.
- Waddling or shuffling gait.
- Audible ‘clicking’ sound coming from the pelvis.
There are typically four classes (or "types") of PFFD, ranging from class A to class D, as detailed by Aitken.
Shin splints, also known as medial tibial stress syndrome (MTSS), is defined by the American Academy of Orthopaedic Surgeons as "pain along the inner edge of the shinbone (tibia)." Shin splints are usually caused by repeated trauma to the connective muscle tissue surrounding the tibia. They are a common injury affecting athletes who engage in running sports or other forms of physical activity, including running and jumping. They are characterized by general pain in the lower region of the leg between the knee and the ankle. Shin splints injuries are specifically located in the middle to lower thirds of the anterior or lateral part of the tibia, which is the larger of two bones comprising the lower leg.
Shin splints are the most prevalent lower leg injury and affect a broad range of individuals. It affects mostly runners and accounts for approximately 13% to 17% of all running-related injuries. High school age runners see shin splints injury rates of approximately 13%. Aerobic dancers have also been known to suffer from shin splints, with injury rates as high as 22%. Military personnel undergoing basic training experience shin splints injury rates between 4–8%.
Pain is the most common cause of lameness in the horse. It is usually the result of trauma or orthopedic disease, but other causes such as metabolic dysfunction, circulatory disease, and infection can also cause pain and subsequent lameness.
Orthopedic causes of lameness are very common and may be the result of damage to the hoof, bone, joints, or soft tissue. Horses are predisposed to orthopedic lameness by conformational flaws, poor hoof balance, working on poor footing, repetitive movements, poor conditioning for a given activity, and competing at a very high athletic level.
Metabolic causes of lameness include hyperkalemic periodic paralysis (HYPP) and polysaccharide storage myopathy, which directly affect muscular function.
Circulatory causes of lameness occur when blood flow to an area is compromised. This may be due to abnormal blood clotting, as in the case of aortic-iliac thrombosis, or decreased blood flow (ischemia) to an area, such as is sometimes seen in laminitis.
Infectious causes of lameness are the result of inflammation and damage to tissue. These include problems such as cellulitis, hoof abscesses, and septic arthritis.
A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments.
It typicals results from a hard blow to the front of the knee or falling on the knee. Occasionally it may occur from a strong contraction of the thigh muscles. Diagnosis is based on symptom and confirmed with X-rays. In children an MRI may be required.
Treatment may be with or without surgery, depending on the type of fracture. Undisplaced fracture can usually be treated by casting. Even some displaced fractures can be treated with casting as long as a person can straighten their leg without help. Typically the leg is immobilized in a straight position for the first three weeks and then increasing degrees of bending are allowed. Other types of fractures generally require surgery.
Patella fractures make up about a percent of all broken bones. Males are affected more often than females. Those of middle age are most often affected. Outcomes with treatment are generally good.