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MBBS - Year 1 > Primary Care - Gait & Limp > Flashcards

Primary Care - Gait & Limp Flashcards

1
Q

Normal gait cycle

A 
Heel strike
Foot flat
Mid-stance
Heel off
Toe off
Swing
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2
Q

Heel strike -gait cycle

A

Initial contact of the heel with the floor

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3
Q

Foot flat - gait cycle

A

Weight is transferred onto this leg

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4
Q

Mid -stance -gait cycle

A

The weight is aligned and balanced on this leg

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5
Q

Heel off -gait cycle

A

The heel lifts off the floor as the foot rises but the toes remain in contact with floor

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6
Q

Toe off -gait cycle

A

As the foot continues to rise, the toes lift off the floor

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7
Q

Swing - gait cycle

A

The foot swings forward and comes back into contact with the floor with a heel strike (and the gait cycle repeats)

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8
Q

Hemiplegic gait

A

Patients with hemiplegic exhibit spastic flexion of the upper limb & extension of the lower limb
Due to the extension of the lower limb (fixed ankle plantar flexion and knee extension) the leg is elongated meaning pts have to circumduct their leg to prevent their foot from dragging on the ground

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9
Q

Clinical features associated with a hemiplegic gait incl

A 
Increased tone with clasp-knife soasticity 
Hypereflexia with or without clonus 
Upgoing plantars (+ve babinski)
Reduced lower 
Sensory deficit
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10
Q

Sensory deficit in hemiplegic gait

A

The pattern of sensory loss depends of the site of the lesion in the nervous system

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11
Q

Causes of hemiplegic gait

A

Unilateral cerebral lesion - stroke, space-occupying lesion (SSL), trauma, MS
Hemisection of the spinal cord - trauma

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12
Q

Clinical findings in diplegic gait

A

Similar to those in hemiplegic gait but are bilateral in nature. Spasticity is typically worse in the lower limbs compared to the upper limbs

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13
Q

Diplegic gait

A

The hips and knees are flexed and abducted whilst the ankles are extended and internally rotated
The knees are forced together due to spasticity in the adductor muscles resulting in leg overlap when walking (aka scissoring)
In an attempt to overcome this adduction, the pt circumducts both legs during the swing phase

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14
Q

Clinical features associated with a diplegic gait

A 
Increased tone with clasp -knife spasticity
Hyperreflexia with or without clonus
Upgoing plantars (+ve babinski)
Reduced power
Sensory deficit 
Wasting and fasciculation
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15
Q

Sensory deficit - diplegic gait

A

If diplegic gait is caused by spinal cord pathology, the ‘sensory level’ (i.e. Lowest dermatome level w/ normal sensation) correlates with the level of spinal card pathology

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16
Q

Causes of diplegic gait

A

Spinal cord lesion (sensation usually affected) - prolapsed IVD, spinal spondylosis, spinal turnour, transverse myelitis, spinal infarcts, syringomyelia, hereditary spastic paraperesis

17
Q

Features of Parkisonion gait

A 
Imitation 
Step length 
Arm swing 
Posture 
Tremor
Turning
18
Q

Imitation - Parkinsonian gait

A

Typicallly slow to start walking due to failure of gait ignition and hesitancy

19
Q

Step length - Parkisonian gait

A

Reduced stride length with short steps is common (shuffling gait). Each step may get progressively smaller as the pt attempts to retain balance (festinant gait)

20
Q

Arm swing - Parkisonian gait

A

Reduced arms swing on one or both sides

21
Q

Posture - Parkisonian gait

A

Flexed trunk and neck causing a stooped appearance

22
Q

Tremor - Parkisonian gait

A

Restimg tremor can be observed when the pt is distracted by walking

23
Q

Turning - Parkisonian gait

A

Impaired balance on turning or hesitancy i common due to postural instability

24
Q

Ataxic gait

A

Typically broad-based and associated with midline cerebellar disease, vestibular disease or loss of proprioception (sensory ataxia)

25
Q

Clinical features associated w/ sensory ataxia

A

+ve Romberg’s sign
Impaired proprioception
Impaired vibration sensation
Absence of other cerebellar signs (e.g. dsymetria, nystagmus, dysarthria)

26
Q

Clinical features associated w/ vestibular ataxia

A

Vertigo
Nausea
Vomiting

27
Q

Myopathic gait

A

AKA waddling or tendelenburg gait
Hip abductor weakness results in an ability to stabilize the pelvis during the stance phase. As a result, the pelvis tilts downwards towards the unsupported side during the unsupported side during the swing phase

28
Q

Causes of myopathic gait

A 
Systemic disease e.g. 
Hyperthyroidism
Hypothyroidism
Cushing's syndrome
Acromegaly
PMR
polymyositis
Dermatomyositis
29
Q

Antalgic gait

A

Abnormal gait pattern-which develops as a result of pain. Typically the stance phase is reduced on the affected leg resulting in a limping appearance

30
Q

Causes of myopathic gait

A

OA
Infl joint disease
Lower limb fracture
Nerve entrapment e.g sciatica

MBBS - Year 1 (93 decks)

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