Diagnostic significance of instrumental and manual methods for quantitative assessment of lower limb difference (review of literature)

Abstract

This article provides a review of the scientific literature over the past 30 years on the assessment of the anatomical or ‘true’ difference in leg length (structural Limb Length Discrepancy, sLLD), as well as a summary of our own clinical experience on this issue.Purpose. Carrying out a systematic analysis of publications on methods for assessing the anatomical difference in leg length and the diagnostic significance of its detection in order to provide highly effective care to patients with diseases of the musculoskeletal system.Materials and methods. The study presents a description of modern hardware and manual methods for assessing sLLD, the shortcomings of their isolated use, and substantiates the need for a comprehensive examination of patients with sLLD with a combination of manual and hardware diagnostic methods.Results and discussion. The results of observations patients with various diseases of the musculoskeletal system and comorbid neurological symptoms are presented. Examples of postural radiographs of patients with anatomical difference in leg length after arthroplasty are given; with persistent functional shortening of the limb of traumatic origin. The possibilities of differentiated correction of pain syndromes of musculoskeletal origin under the influence of an anatomically short leg on pelvic skew, scoliosis in the form of lift therapy, and the possibility of manual correction in upslip functional dysfunction are considered.Conclusions. An unrecognized and not timely compensated structural difference in the length of the legs is one of the main causes of asymmetries in posture, increased fatigue and chronic pain of the musculoskeletal system, as well as a consequence of subjectivity, insufficient reliability and accuracy of many direct methods proposed in the literature for quantifying the difference in leg size. The low threshold of clinical significance of sLLD, along with the wide prevalence of this phenomenon in the population, dictates the need for increased diagnostic alertness of specialists in order to provide effective assistance to this group of patients through the combined use of pharmacotherapy, manual techniques and adequate orthopedic correction