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60 year old male. Right knee degenerative, left knee - early signs and symptoms of degenertaive knee. No xrays of hip, however patient has discomfort in hips, however location of pain in hip and hamstrings - undefined.
Gait: externally rotated bilaterally,
Excessive movement of left pelvis through swing. RF pronation contact through to propulsion.
Main issues from biomechanical analysis:- hip fixed in external rotation on right (no internal rotation), left minimal internal rotation
- malleolar torsion 22 degrees roughly bilaterally, femoral component appears to be in a greater externally rotated position
- limb length assessment - right tibia close to 1cm shorter - in stance pelvis and shoulder - appears level
- jacks test positive bilaterally - improved with foot correction
- supination resistance moderately hard bilaterally
- elongated first bilaterally
- lunge test positive
- arch profile - left more planus than right
- RCSP left 2 evr, right 4 evr
Due to the fixed external position, I believe pronation has increased. Because there is basically no internal rotation possible through swing of the hip, and femur.
Could controlling the pronation possibly cause more issues (hip, back, knee) ie with shock related issues etc. Is this pronation necessary now that there is no or little internal hip rotation. Or should this compensatory pronation be addressed?
Due to the fixed externally rotated position of the right hip, is this causing the left pelvis to move forward anteriorly, to compensate for a lack of internal rotation. My thoughts are this, and that this pelvic motion is causing increased lumbar motion etc possibly increasing spinal nerve impingement etc.
Also does anyone have any suggestions to the prevention of the forward movement of the left pelvis?
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