Pathological Gaits

Question 1

Antalgic description and treatment

Answer 1

Walk to reduce pain e.g. OA of hip

Limp, shortening stance phase of painful limb so shortens swing phase of affected limb. Uneven.

✅Often use walking stick in hand opposite painful limb, lean towards stick reduce load

Question 2

Trendenlenburg what, 7 causes

Answer 2

Positive sign - stance phase pelvis drops on unaffected side (when this leg in air), often try swing torso towards affected side ‘waddling’

Superior gluteal nerve palsy (supplies abductors of hip gluteus medius and minimus) lesion ->weakness abduction, injured hip surgery, buttock injections, greater trochanter fracture, dislocation of hip, muscle pain and inhibition (hip OA), Biomechanical hip instability (developmental dysplasia of hip)

Question 3

Hemiplegic what, cause

Answer 3

Paralysis one side of body e.g. post stroke, cerebral palsy, trauma CNS (head injury, spinal cord injury) -> spasticity (continuous contraction) of affected side.

Flexed upper limb and extended lower limb. Can’t flex hip/knee/ ankle, lean towards unaffected side then circumduct paralysed leg. Stance phase on affected leg short, so short step of unaffected leg.

Question 4

Diplegic what, cause

Answer 4

Spasticity affects both limbs e.g. cerebral palsy

Narrow-based, dragging both legs and scraping toes, legs may cross midline (scissoring), knees slightly flexed, plantar-flexion. Forefoot initial contact with ground.

Question 5

High- steppage what, causes

Answer 5

Weakness ankle dorsiflexion -> foot drop

Common Peroneal nerve palsy (following fracture neck of fibula/ compression nerve tight plaster cast/ peripheral neuropathy), sciatica (L4 myotome dorsi-flexes), neuromuscular disease (Charcot-marie-tooth disease)

When foot raised in swing phase plantar-flexes, flex hip to lift foot high, initial contact foot slaps ground.

If deep perineal nerve damaged but superficial intact -> every foot ‘eversion flick’ instead of plantar-flexion in swing phase

Question 6

Parkinsonian what, cause

Answer 6

Parkinson’s disease: Nerve cells in subtantia nigra degenerate-> reduced dopamine (regulates body movement)

Difficult initiate movement, flex neck and trunk forwards, short steps ‘shuffling’, ‘festinant’ accelerating steps, loss arm swing.

Question 7

Ataxic what, cause

Answer 7

Propriceptive , cerebellar disease, vestibular (damage to organs of balance inner ear)

Cerebellum co-ordinates elements of movement, dysfunction: inherited, acquired (stroke), acute alcohol intoxication

Clumsy, staggering, broad-base, hold arms out, when still may sway back and forth/ side to side ‘titubation’. Not able to walk heel to toe or in straight line.