How Leg Length Discrepancy (LLD) Causes Scoliosis
Leg Length Discrepancy (LLD) can lead to scoliosis by creating an imbalance in the pelvis and
spine. Here's how:
1. Pelvic Tilt:
The shorter leg causes the pelvis to tilt down on that side.
The longer leg pushes the pelvis upward on the opposite side.
2. Compensatory Curve Formation:
To maintain balance and keep the eyes level (compensating for the pelvic tilt), the spine
curves laterally, forming a functional scoliosis.
This compensatory curve usually forms with the convexity toward the side of the
shorter leg.
3. Progression to Structural Scoliosis:
If the LLD is significant (>20mm) or persists over time, the functional scoliosis can
develop into a structural scoliosis, with fixed rotational and structural changes in the
vertebrae.
Rib Hump (Gibosity) and its Relationship to LLD
The rib hump (gibosity) observed during the Adam's test occurs due to vertebral rotation in
scoliosis. Its relationship to the longer or shorter leg depends on how the scoliosis develops:
In functional scoliosis due to LLD:
The convexity of the lumbar curve is typically on the shorter leg side, and any thoracic
curve's convexity will usually be toward the longer leg.
The gibosity (rib hump) will appear contralateral to the longer leg if the thoracic spine
develops a curve.
In structural scoliosis with a thoracic curve:
The rib hump reflects the side of the convexity of the thoracic curve, which can align
with or be influenced by other factors, such as the primary spinal deformity rather than
the LLD alone.
Application to Your Case
In your case, the boy has:
1. A longer left leg.
2. A right-sided rib hump.
This likely indicates:
The lumbar curve's convexity is toward the shorter right leg (concave on the left), while the
thoracic curve has convexity on the right, leading to the rib hump.
The rib hump (giba) is contralateral to the longer leg in this scenario.
