Short Right Leg Syndrome Assessment - Three Cardinal Signs

 

In some instances, subjects exhibit symptoms resulting from a structural leg length discrepancy that is so small it is difficult to detect by simple examination without the use of X-Ray equipment. However, the effect a discrepancy has on the body is amplified generating Cardinal Signs that are easy to detect by palpation. In practice, I use these Cardinal Signs to confirm the possibility a short leg is contributing to presenting symptoms before attempting a leg length assessment. The Three Cardinal Signs of SRLS are:

 

I.   Anterior rotation of the left hip. That is, in a standing position the ASIS will be lower than the Iliac Crest as the hip rotates in the Sagittal Plane about the centre of rotation at the SIJ. This is an unconscious anatomic adjustment functionally pulling up the longer leg to reduce pelvic tilt making us feel more comfortable and protecting the lumbar spine to some degree. The side of the short leg will typically be level.

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II.   Rigidity at the right hip from the QL's in the lower lumbar region through to the adductors in the groin. Tightening and tenderness often evident in the right QL's due to the right leaning pelvic tilt causing mild right sided disk bulging through the lumbar region. The SIJ can be stuck and manipulative therapists will attempt to mobilise the joint. ROM through the Femoro-Acetabular joint of the short leg will be limited…most noticeable in lateral rotation. Tractioning legs from the ankles reveals free movement through the joint on the side of the long left leg and a rigidity and woodenness at the hip of the short right leg. 

 

III.   Sign of mild right leaning scoliosis commonly displaying a right convexity through the Thoracic. More readily palpated than seen. With the subject prone a bulging rib cage and more developed and tight spinal erectors through the middle and lower Thoracic on the side of convexity. The opposite side will be flattened. Less common is a mild right leaning Lumbar scoliosis with Thoracic convexity to the left despite the right leaning Frontal pelvic tilt...owing to a switch back occurring in the vicinity of the juncture between the lumbar and thoracic. These exceptions are usually lower range cases of leg length discrepancy.