Hand-knee gait is seen in patients of: March 2013 (b, e)
Ans. C i.e. Polio Hand knee gait Extend of the paralysis in the lower limbs determines the walking ability of the patient with poliomyelitis. When one leg has a normal or nearly normal muscles power, and some residual power in the antigravity muscles (gluteus maximus, quadriceps, and triceps surae) of the other limb, the patient can walk without external suppo. If the flexion contracture develops in the knee joint of the effected limb, they often assume a hand-knee gait. Normally, the knee joint extends at heel strike, if it is unable to extend because of a weak quadriceps (unstable knee gait) or if the knee is fused in flexion, the patient will try to push it into extension with his hand. The hand-knee gait causes lurch in the limbs, which is tiring and painful. Many Patients fall down frequently and suffer injuries and fractures. Some abnormal gait patterns & causes Cerebellar - think drunk people. - Wide base/reeling on a narrow base; - Patient falls to side of lesion; - Feet raised excessively and placed down carefully. - The cerebellum deals with fine control. - Seen in any lesion of the cerebellum. - There are a whole heap of causes but these are the most impoant: CVA, alcohol, tumour, MS (multiple sclerosis) High-stepping - this is foot-drop. - Remember the "heel-on, toe-off" from above? - It's the opposite. - Foot doesn't dorsiflex before touching the ground. - In order to not trip over, patient need to lift it really high. - It dangles (hence "foot-drop") and lands toes-first. Causes include ? Local: common peroneal nerve palsy, sciatic nerve palsy, distal myopathy; spine: L4,5 root lesion; Generalised: peripheral neuropathy (alcohol, diabetes), motor neurone disease. Parkinsonian - this type of gait has a lot of specific features but the mains ones are: TRAPS- Resting tremor, Rigidity, Akinesia, Stooping posture, Shuffling gait - Mainly seen in idiopathic parkinson's disease. Sensory ataxia - broad base, bangs feet down clumsily (may have foot-drop), looks at feet throughout gait cycle. - Positive Romberg's sign.; - Generalised: peripheral neuropathy; - Spinal cord: cervical spondylosis, MS, B12/folate deficiency and bizarrely syphillis. Scissor - typical of cerebral palsy. - Walking on tip-toes (plantar flexed feet), flexed kneed, adducted and internally rotated hip, ridigity, excessive adduction in leg swing and contractures in all spastic muscles. Waddling - broad-base; duck-like waddle; - Pelvis tilts away from lifted leg; - Forward curvature of lumbar spine; and - Marked body swing. - CDH, proximal myopathy, being overweight and being pregnant Antalgic - patient leans on affected side taking rapid, heavy step. - The step on the unaffected side is slower. Usually caused by hip osteoahritis.
Leprosy
TB
Polio
Common peroneal nerve palsy