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X-rays for leg length measurement.. Unequal leg length in children is frequently first suspected by parents noticing a limp that appears to be getting worse. [3] The standard workup in children is a thorough physical examination, including observing the child while walking and running. [3]
Clinical feature: presents after the child has started walking but before six years of age. Usually associated with a painless hip due to mild abductor weakness and mild limb length discrepancy. If there is a bilateral involvement the child might have a waddling gait or trendelenburg gait with an increased lumbar lordosis.
Stabilize the pelvis and let the affected leg drop. A positive test is indicated if the leg does not adduct to the table. [1] Thomas test for tight hip flexors both performed by the provider holding the unaffected leg to the chest and leaving the affected leg on the table. If the affected leg cannot lie flat on the table it is a positive test. [1]
Klein's line or the line of Klein is a virtual line that can be drawn on an X-ray of an adolescent's hip parallel to the anatomically upper edge of the femoral neck.It was the first tool to aid in the early diagnosis of a slipped capital femoral epiphysis (SCFE), which if treated late or left untreated leads to crippling arthritis, leg length discrepancy and lost range of motion.
Although prone "functional leg length" is a widely used chiropractic tool, it is not a recognized anthropometric technique, since legs are often naturally of unequal length, and measurements in the prone position are not entirely valid estimates of standing X-ray differences. [10] Measurements in the standing position are far more reliable. [11]
This constitutes a positive Thomas test. [2] Sometimes, with a very flexible patient, the Thomas test will be normal despite a psoas dysfunction being present. However, in the patient with a normal hip joint, a positive test is a good indicator of psoas hypertonicity. [2] Other signs from the Thomas test:
The Galeazzi test, also known as the Allis sign, is used to assess for hip dislocation, primarily in order to test for developmental dysplasia of the hip. It is performed by flexing an infant's knees when they are lying down so that the feet touch the surface and the ankles touch the buttocks .
limb length discrepancy (evaluated by placing the child in a supine position with the hips and knees flexed [unequal knee heights might be noticed – the Galeazzi sign]), and; restricted hip abduction. Sometimes during an exam a "click" or more precisely "clunk" in the hip may be detected [24] (although not all clicks indicate hip dysplasia). [25]