Lurching Gait is due to paralysis of which of the following ?
ANSWER: (A) Gluteus mediusREF: Grays anatomy, 39thedition, page 1450Also, check APPENDIX-3 below for a list of "Gait abnormalities"CLINICAL TESTING OF GLUTEUS MEDIUS AND MINIMUS:"Sufferers from unilateral paralysis of gluteus medius and minimus have a characteristic lurching gait".Hip girdle muscles are responsible for keeping the pelvis level when walking. Weakness on one side will lead to a drop in the pelvis on the contralateral side of the pelvis while walking (Trendelenburg sign, lurching gait). With bilateral weakness, there will be dropping of the pelvis on both sides during walking leading to waddling. This gait is seen in a patient with bilateral superior gluteal nerve injury and myopathies, such as muscular dystrophy.Positive Trendelenburg's sign due to Injury to Superior Gluteal Nerve:The Trendelenburg's sign is said to be positive if, when standing on one leg, the pelvis drops on the side opposite to the stance leg. The weakness is present on the side of the stance leg. The body is not able to maintain the center of gravity on the side of the stance leg. Normally, the body shifts the weight to the stance leg, allowing the shift of the center of gravity and consequently stabilizing or balancing the bodyHowever, in unilateral superior gluteal nerve injury, when the patient lifts the opposing leg, the shift is not created and the patient cannot maintain balance leading to instability (Lurching gait). Bilateral superior gluteal nerve injury results in a waddling gait.NOTE: Not to be confused with Trendelenburg's sign. The Trendelenburg Test or Brodie-Trendelenburg test is a test which can be carried out as part of a physical examination to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins. APPENDIX - 3GaitAlso Known asDescriptionFound InHemiparetic gaitCircumduction gait, Pyramidal gaitMild cases: the only indication of paresis may be that the ball/heel of the shoe may be worn more on the affected side.Hemiplegia (upper motor neuron disease)Severe cases: knee extended, ankle plantarflexed. The patient therefore circumducts the affected leg to ambulate Ataxic gaitBroad-based gaitpatient spreads legs apart to widen the base to compensate for the imbalance while standing or walkingCerebellar sign, alcoholismLurching gaitJack knife gait. Gluteus Maximus LurchThe trunk lurches back on the stance phase side hyperextendingGluteus Maximus weakness Trendelenburg's gait, Gluteus medius lurchThe trunk shifts over the side of the weak muscle in stance phase to minimize the fall of the swing phase side of the pelvis.Hip dislocation Coxa vara Short limb Unilateral superior gluteal nerve injuryWaddling gaitMyopathic gaitThe patient uses circumduction to compensate for gluteal weaknessMuscular dystrophy Bilateral superior gluteal nerve injuryShuffling gaitFestinating gaitShort steps appears to shuffle his or her legs rather than put them forward, steps and pace may vary with a tendency for the patient to accelerateParkinson'sdisease(extrapyramidal)Stepping gaithigh-stepping,slappinghigh steps as if climbing stairs while walking on a level surface, trying to avoid injury to the feet (from dragging them) by stepping highperipheral neuropathies (bilateral foot drop)Spastic gaitScissoring gaitlegs are held in adduction at the hip and the thighs rub against each other as the patient walksCerebral diplegia (cerebral palsy)Charlie Chaplin gaitOut toe gaitspread-eagle' or frog leg positionTibial torsionAntalgic gait Patient favors the affected painful extremity and walks, putting weight on the normal legLimb pain
Gluteus medius
Hamstrings
Quadriceps femoris
Adductor Magnus