TF: Adductor Longus O/Load
Ryan Kelly
Description
Collection
Title:
TF: Adductor Longus O/Load
Creator:
Ryan Kelly
Date:
8/11/2020
Text:
Hi All,
I'm interested if anyone else has come across this issue- and found a solution, or if anyone has any suggestions.
56y.o Male. Short Trans-Femoral amputee.
Amputation at 19y.o due to trauma.
The Problem: Reports that he has adductor pain on (L) LL when he has walked for 30m. This is a strong aching pain. Often this will cause him to stop - once he has had 1 minute's rest this will subside and he can move again. Pain seems to peak in late stance- swing initiation.
Palpation: TOP over adductors insertion>mm belly
Resisted movements (flexion/extension/abduction/adduction) all non-painful and strong
Stretch out into abduction (in flexion due to positioning) not painful for patient
U/S has reportedly cleared of any structural changes.
Prosthetically was managed for many years in plug fit socket with pelvic band. Reports that he could walk without pain/fatigue all day long.
Maceration of the skin on his stump due to sweating in socks (we live in a tropical climate) led to a change is socket design to a skin fit suction socket- with no pelvic band.
He is on a Total Knee 2000 and a Celsus Foot.
Gait: excessive (L) lateral trunk flexion and extension in (L) stance - decreased lateral pelvic translation to the (L) for stance phase - resulting in abduction of hip at terminal stance and pre-swing. Due to biomechanics in this position, adductors may be working to bring hip into flexion therefore causing pain ? if this is due to the muscle power required to break the knee for swing
Initial though was that it was a socket fit issue- but this is not the case.
We have tried multiple check socket designs. Seal in liner- with different adapter/ alignment without success. We have increased the shims in the front of the knee to make initiating swing easier. We have tried a pelvic band with a seal-in liner socket. We have trialed a C-Leg- which he found the transition very difficult to adapt to.
None of these trials have been able to reduce this o/loading that seems to be occurring in his Adductor.
My hunch is that it is related to his inherent lateral trunk movement in gait-which at his age and prosthetic experience would be difficult to train out.
Has anyone come across anything similar? or have any thoughts on possible options that might help this man.
Recent Cardiac Stenting has improved his walking capacity by about double- but ulitmatley the same pain returns.
Many Thanks.
Ryan Kelly
CPO
Australia
I'm interested if anyone else has come across this issue- and found a solution, or if anyone has any suggestions.
56y.o Male. Short Trans-Femoral amputee.
Amputation at 19y.o due to trauma.
The Problem: Reports that he has adductor pain on (L) LL when he has walked for 30m. This is a strong aching pain. Often this will cause him to stop - once he has had 1 minute's rest this will subside and he can move again. Pain seems to peak in late stance- swing initiation.
Palpation: TOP over adductors insertion>mm belly
Resisted movements (flexion/extension/abduction/adduction) all non-painful and strong
Stretch out into abduction (in flexion due to positioning) not painful for patient
U/S has reportedly cleared of any structural changes.
Prosthetically was managed for many years in plug fit socket with pelvic band. Reports that he could walk without pain/fatigue all day long.
Maceration of the skin on his stump due to sweating in socks (we live in a tropical climate) led to a change is socket design to a skin fit suction socket- with no pelvic band.
He is on a Total Knee 2000 and a Celsus Foot.
Gait: excessive (L) lateral trunk flexion and extension in (L) stance - decreased lateral pelvic translation to the (L) for stance phase - resulting in abduction of hip at terminal stance and pre-swing. Due to biomechanics in this position, adductors may be working to bring hip into flexion therefore causing pain ? if this is due to the muscle power required to break the knee for swing
Initial though was that it was a socket fit issue- but this is not the case.
We have tried multiple check socket designs. Seal in liner- with different adapter/ alignment without success. We have increased the shims in the front of the knee to make initiating swing easier. We have tried a pelvic band with a seal-in liner socket. We have trialed a C-Leg- which he found the transition very difficult to adapt to.
None of these trials have been able to reduce this o/loading that seems to be occurring in his Adductor.
My hunch is that it is related to his inherent lateral trunk movement in gait-which at his age and prosthetic experience would be difficult to train out.
Has anyone come across anything similar? or have any thoughts on possible options that might help this man.
Recent Cardiac Stenting has improved his walking capacity by about double- but ulitmatley the same pain returns.
Many Thanks.
Ryan Kelly
CPO
Australia
Citation
Ryan Kelly, “TF: Adductor Longus O/Load,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/255134.
