12/8 Gait + Nerve Lesions Flashcards
What is the gait cycle?
Series of rhythmical, alternating movements of the trunk and limbs which result in the forward progression of the center of gravity (series of ‘controlled falls’)
What are the two phases of gait?
- Stance/ Support phase (weight bearing)
- Swing phase (non‐weight bearing)
What happens during the initial contact (heel strike) of muscle function during gait?
Collision of heel with ground, shock absorbance
What muscle groups are involved in heel strike?
Dorsiflexors, hip extensors
What happens during the foot flat stage of muscle function during gait?
Transition from shock absorbing towards propulsion
Eccentric to isometric contractions
What muscle groups are involved in foot flat stage?
Knee extensors (accept weight)
Plantarflexors (decelerate mass)
Hip abductors (stabilize pelvis)
What happens in the midstance stage of gait?
Stabilization as movement proceeds forward
Mostly isometric contractions (will quickly switch to concentric)
What muscle groups are involved in the mid stance stage of gait?
Knee extensors (stabilize knee)
Plantarflexors
Hip adbuctors (stabilize pelvis)
What happens in the heel off and toe off stage of gait?
Propulsion
Primarily concentric muscle contractions - dorsiflexion
What muscle groups are involved in the heel off stage of gait?
Plantar flexors (accelerate mass)
Hip abductors (stabilize pelvis)
What muscle groups are involved in the toe off stage of gait?
Intrinsic foot muscles
Flexor of hip
What happens in the initial swing and mid swing stage of gait?
Acceleration of the limb (advancement)
Clearance of the foot (prevents tripping!)
What muscle groups are active in the initial swing and mid swing stage of gait?
Hip flexors (accelerate thigh)
Dorsiflexors (clear foot)
What happens in the terminal swing stage of gait?
Deceleration of the limb
Primarily eccentric muscle contractions
What muscle groups are active in the terminal swing stage of gait?
Hip extensors (decelerate thigh)
Knee flexors (decelerate leg)
Dorsiflexors (position foot)
Knee extensors (extend knee to place foot)
What are the characteristics of antalgic gait?
Gait pattern in which stance phase on affected side is decreased
Corresponding increase in stance time on unaffected side
What are causes of antalgic gait?
Osteoarthritis (OA)
Facture (Fx)
Tendinitis
Ankle sprain
Anything that causes pain upon weight bearing
What are the types of leg-length discrepancy gait?
Compensations of swing limb (longer limb)
Compensations of stance limb (shorter limb)
What are the gait types for compensation of swing limb (longer limb)?
Circumduction Gait (limbs swings out laterally to clear ground)
Steppage Gait (increased hip flexion)
What are the gait types for compensation of stance limb (shorter limb)?
Hip Hike Gait (‘reverse Trendelenburg’, increased use of hip abductors on stance limb)
Vaulting Gait (increased plantar flexion on stance limb)
What are causes of lateral cutaneous femoral nerve pain? Where do these occur?
Causes: entrapment behind inguinal ligament, tight pants or belt, obesity
Location: pain over ‘hip pocket’ area
What are causes of posterior cutaneous femoral nerve pain? Where do these occur?
Causes: direct falls, cyclists
Location: pain on posterior thigh
What are causes of saphenous nerve pain? Where do these occur?
Causes: thrombophlebitis of great saphenous vein, entrapment in sartorius
Location: pain on medial side of leg and foot
What are causes of sural nerve pain? Where do these occur?
Causes: thrombophlebitis of small saphenous vein
Location: pain over lateral border of ankle and foot
What are causes of superior gluteal nerve lesion?
Intramuscular injections, penetrating wounds
What is the compartment and function of the motor loss of a superior gluteal nerve lesion?
Compartment: lateral compartment of gluteal region
Function: abduction, lateral/medial rotation of thigh
Is there sensory loss with a superior gluteal nerve lesion?
No
What is the effect on gait with a superior gluteal nerve lesion?
Trendelenburg gait
What are the two common types of trendelenburg gait?
Compensated (trunk bends to affected side)
Uncompensated (hip drop when standing on affected side)
What are the causes of trendelenburg gait?
Superior gluteal nerve lesion, osteoarthritis, weak hip abductors
What are causes of an inferior gluteal nerve lesion?
Penetrating wounds, intramuscular injections
What is the compartment and function of the motor loss of an inferior gluteal nerve lesion?
Compartment: posterior compartment of gluteal region
Function: extension and lateral rotation of thigh
Is there sensory loss with an inferior gluteal nerve lesion?
No
What is the effect on gait of an inferior gluteal nerve lesion?
Backward lurch gait
What are the characteristics of backward lurch gait?
Backward lean of the trunk during early stance phase
Shifts gravity posterior to the hip, reducing the demands of the hip extensors and allows anterior capsule of the hip joint to bear the force (iliofemoral ligament)
What are causes of backward lurch gait?
Inferior gluteal nerve lesion, weak hip extensors, hamstring injury
What are the most noticeable deficits in inferior gluteal nerve lesions? What muscle is critical for these?
Rising from a chair, walking up stairs
Gluteus maximus
What are causes of a femoral nerve lesion?
Vascular Disease, retroperitoneal hemorrhage, trauma, entrapment in psoas muscle
What is the compartment and function of the motor loss of a femoral nerve lesion?
Compartment: anterior compartment of thigh
Function: flexion of thigh, extension of knee, patellar reflex
Is there sensory loss with a femoral nerve lesion?
Medial and anterior thigh, medial leg and foot
What is the effect on gait of a femoral nerve lesion?
Knee hyper-extension gait
What are the characteristics of knee hyper-extension gait?
Knee goes into hyperextension during the stance phase instead of maintaining slight flexion
Knee joint extends so that quads do not have to work
What are causes of knee hyper-extension gait?
Femoral nerve lesion
Quadriceps weakness
Hyperextension deformity of knee (genu recurvatum)
Quadriceps spasticity (CNS lesion)
What are causes of an obturator nerve lesion?
Trauma, pelvic fraction, childbirth, ovarian cancer
What is the compartment and function of the motor loss of a obturator nerve lesion?
Compartment: medial thigh
Function: adduction and medial rotation of thigh
Is there sensory loss with an obturator nerve lesion?
Medial aspect of thigh
What is the effect on gait of an obturator nerve lesion?
Wide stance gait
What are the characteristics of a wide stance gait?
Normal walking base is with feet 5‐10 cm apart
Lateraloscillationsor circumduction
What are causes of a wide stance gait?
Obturator nerve lesion
Balance deficits (CNS)
Obesity
Young children learning to walk
What are causes of a sciatic nerve lesion
Herniation of IV disc, intramuscular injection, entrapment in piriformis muscle
What is the compartment and function of the motor loss of a sciatic nerve lesion?
Compartment: entire posterior lower limb and anterior leg and foot
Function: extension of thigh, flexion of knee, flexion and extension of ankle and foot
Is there sensory loss with a sciatic nerve lesion?
Posterior thigh, lateral and anterior leg
What is the effect on gait of a sciatic nerve lesion?
If foot and ankle are in a rigid brace, they can sometimes ambulate using quads and gluteal muscles
What are causes of a tibial nerve lesion?
Penetrating wounds, popliteal aneurysm, *tarsal tunnel syndrome
What is the compartment and function of the motor loss of a tibial nerve lesion?
Compartment: posterior leg and sole of foot
Function: plantar flexion, flexion of digits, arch support
Is there sensory loss with a tibial nerve lesion?
Plantar aspect of foot
What are causes of a common fibular nerve lesion
Fraction of neck of fibula, compression by cast
What is the compartment and function of the motor loss of a common fibular nerve lesion?
Compartment: lateral and anterior leg
Function: dorsiflexion, eversion, extension of digits
Is there sensory loss with a common fibular nerve lesion?
Lower, lateral leg and dorsum of foot
What is the effect on gait of a common fibular nerve lesion?
Foot drop/steppage gait (or other limb length discrepancy gaits)
What are the characteristics of foot drop/steppage gait (or other limb length discrepancy gaits)
Foot drop or slap after heel strike
Toe drag (trip/ fall risk)
If hip flexors are strong, may exhibit a high stepping gait to clear toe from ground during swing phase
What are causes of foot drop/steppage gait (or other limb length discrepancy gaits)?
Common or Deep Fibular nerve lesion
Weakness of Tibialis Anterior muscle
What are causes of superficial fibular nerve lesions?
Similar to common fibular, chronic lateral compartment syndrome
What is the compartment and function of the motor loss of a superficial fibular nerve lesion?
Compartment: lateral leg
Function: eversion and plantar flexion
Is there sensory loss in a superficial fibular nerve lesion?
Lower, lateral leg and dorsum of foot except web space between first and second digits
What is the effect on gait of a superficial fibular nerve lesion?
Instability when walking over uneven surfaces
What are causes of a deep fibular nerve lesion?
Similar to common fibular, anterior compartment syndrome, also vulnerable on dorsum of foot between tendons (tight boots)
What is the compartment and function of the motor loss of a deep fibular nerve lesion?
Compartment: anterior leg and dorsum of foot
Function: dorsiflexion, inversion (eversion?), extension of digits
Is there sensory loss in a deep fibular nerve lesion?
Web space between first and second digits
What is the effect on gait of a deep fibular nerve lesion?
Drop foot/steppage gait
What is a good way to remember the dermatomal patterning of the limb?
L3 to knee
L4 to floor
Extension in the hip involves these spinal levels
L4, L5
Flexion of the hip involves these nerve levels
L2, L3
Flexion of the knee involves these spinal levels
L5, S1
Extension of the knee involves these spinal levels
L3, L4
What is center of gravity like in the lower limbs?
Posterior in thigh
Anterior in knee/leg
Far anterior in foot
What nerve lesions can cause foot drop/steppage gait? How do you differentiate which nerve is the cause?
Common fibular nerve, deep fibular nerve
Common fibular nerve sensory is lower, lateral leg and dorsum of foot
Deep fibular nerve sensory is the web space between first and second digits
