Differential Diagnosis of Limb Length Discrepancy in a 19th Century Burial from Southwest Mississippi

Abstract

This paper reports on a 19th century skeleton from southwest Mississippi that displays shortening of several right side bones. Most notable is a 50-mm discrepancy in leg length involving the tibiae and fibulae. Osseous changes in the right foot suggest limited muscle function was present in this area. However, the shortened tibia and fibula show no signs of atrophy. After considering both osteological features and burial context, it is concluded that the individual was likely exposed to the poliovirus during childhood. While this diagnosis does not conform to the skeletal expectations of polio based on most paleopathological descriptions, the deformities observed fit within the range of what has been reported clinically. Based on this finding, it is suggested that polio should be considered as an etiological source of limb shortening even when signs of diffuse skeletal atrophy are lacking.

Possible neurogenic disorder in a female buried in the monastic cemetery at Ghazali (ca. 670–1270 CE), northern Sudan

“…The tandem occurrence of lower limb shortening, loss of bone volume, and osteoporosis is most often considered indicative of juvenile poliomyelitis in the paleopathological literature (Thompson, ). CP is most often a diffuse condition, affecting both upper and lower extremities (Werner, ), whereas clinical cases of poliomyelitis are usually limited to atrophy and shortening of one or both lower limbs (Ratliff, ; Sharrard, ).…”

“…Monoplegia of one lower limb resulting in atrophy is to be expected in cases of full onset of poliomyelitis (Colonna & Vom, ; Jesus, ). In fact, in numerous archaeological cases where involvement of one or both lower extremities was recorded, the cause was identified as poliomyelitis (Gładykowska‐Rzeczycka & Śmiszkiewicz‐Skwarska, ; Kozlowski & Kowalski, ; Kozlowski & Piontek, ; Thompson, ). CP has been pointed to in cases where involvement of both upper and lower extremities was observed (Tesorieri, ; Novak et al, ).…”

“…Trauma and rickets are not discussed at length. Although traumatic injuries can certainly produce skeletal changes in the form of bowing and shortening of bones (Thompson, ), they are unlikely to cause muscular atrophy and bone mass decrease in the whole lower left extremity, especially with no sign of fracture in any of the skeletal elements. In terms of rickets, although vitamin D deficiency may cause bowing in the lower extremities, restriction of such deformation to one side of the body does not fit with an aetiology of rickets (Brickley & Ives, ).…”

The changing shape of palaeopathology: The contribution of skeletal shape analyses to investigations of pathological conditions

“…Poliomyelitis has the potential to develop into a paralytic form that can affect various body regions in varying patterns (Smallman‐Raynor et al, 2006). In studies by Thompson (2014) and Berner et al (2021), the authors used different approaches to quantify the cross‐sectional shape of long bones and identify evidence for asymmetry that could be linked with post‐polio paralysis. In both cases, individuals with lower limb asymmetry were identified, and Berner et al (2021) also considered humeri and included histomorphometric analyses.…”

Beyond Mortality

“…-1-0-+1- Modern bio archae ol o gi cal studies have discussed possible cases of the paralytic form of poliomyelitis in archaeological skeletons based on the observation of skeletal traits indicative of the associated disuse and altered function. The most commonly reported skeletal changes include shortened limbs, bone atrophy, and torsion and abnormal curvature of long bones (Castells Navarro et al 2017;Ciesielska and Stark 2020;Gładykowska-Rzeczycka and Śmiszkiewicz-Skwarska 1998;Kozlowski and Piontek 2000;László 2017;Novak et al 2014;Thompson 2014). Scoliosis and skeletal evidence of clubfoot are also regularly mentioned (e.g., Castells Navarro et al 2017;Winkler and Grosschmidt 1988).…”