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Symptoms and Signs – Differential Diagnosis of Scissors Gait
The scissors gait, which arises from bilateral spastic paresis (diplegia), impacts both legs and has minimal or no impact on the arms. The patient exhibits partial flexion of the legs at the hips and knees, giving the impression of squatting. With every stride, his thighs contract and his knees strike or intersect in a sharp, slicing motion.
His strides are brief, consistent, and arduous, as if he were deftly navigating through water up to his waist. The patient's feet exhibit plantar flexion and inward turning, accompanied by a shortened Achilles tendon. Consequently, he walks on his toes or on the balls of his feet, potentially causing scraping of his toes on the ground.
Histories and Physical Assessment
Prompt the patient (or a family member, if the patient is unable to respond) regarding the beginning and length of the walking pattern. Has it exhibited sequential deterioration or maintained a stable state? Request information regarding a past record of trauma, encompassing birth trauma, as well as neurological problems. Evaluate motor and sensory function, as well as deep tendon reflexes (DTRs), in the legs comprehensively.
Medical etiology
Cerebral palsy
Individuals with the spastic variant of cerebral palsy exhibit a scissors gait when walking on their toes. Additional characteristics include heightened activation of deep tissue receptors (DTRs), heightened stretch reflexes, fast and alternating contraction and relaxation of muscles, muscular weakness, underdevelopment of the affected limbs, and a propensity for contractures.
Cervical spondylosis with myelopathy
Scissors gait emerges during the advanced phases of cervical spondylosis accompanied by myelopathy and progressively deteriorates thereafter. Corresponding symptoms resemble those of a herniated disk: intense lumbar pain that can extend to the buttocks, legs, and feet; muscular spasms; loss of sensory perception; and muscular weakness and wasting.
Multiple sclerosis (MS)
Typically, progressive scissors gait progresses gradually, with occasional remissions. Distinctive muscular weakness, often in the legs, varies from little fatigue to paraparesis accompanied by urine urgency and constipation. Additional diagnostic features encompass face pain, visual impairments, paresthesia, lack of coordination, and diminished proprioception and vibration perception in the ankle and toes.
Spinal cord tumor
Scissors gait may progress gradually from a tumor located in the thoracic or lumbar region. Additional symptoms indicate the specific site of the tumor and may encompass pain in the radicular, subscapular, shoulder, groin, leg, or flank regions; muscle spasms or fasciculations; muscle atrophy; sensory impairments, such as paresthesia and a girdle sensation in the abdomen and chest; hyperactive ductal tunnel receptors; a bilateral Babinski's reflex; spastic neurogenic bladder; and sexual dysfunction.
Syringomyelia
Scissors gait often manifests relatively late in syringomyelia, accompanied by analgesia and thermanesthesia, muscular atrophy and weakening, and the presence of Charcot's joints. Additional consequences may encompass the detachment of fingernails, fingers, or toes; Dupuytren's contracture of the palms; deviation from normal spinal alignment; and clubfoot. Skin in the afflicted regions often exhibits dryness, scaliness, and grooves.
Key Factors to Consider
Administer thorough skin care to avoid skin breakdown and the development of pressure ulcers due to the sensory loss caused by scissors gait. Furthermore, provide the patient and his family with comprehensive guidelines for skin care. If deemed suitable, proceed with bladder and bowel retraining.
Incorporate daily regimens of both active and passive range-of-motion exercises. Consultation with a physical therapist may be necessary for gait retraining and other in-shoe modifications.
Application of splints or leg braces to ensure correct foot alignment during standing and walking.
Therapeutic Counseling for Patients
Provide the patient and his family with comprehensive guidance on skin care. If deemed suitable, educate them on bladder and bowel retraining. Emphasise the correct application of splints or braces, if suitable.
Guidelines for Pediatric Populations
Primary etiologies of scissors gait in children include cerebral palsy, inherited spastic paraplegia, and congenital spinal damage. The presence of spastic paraplegia at birth results in the manifestation of scissors gait when the infant starts walking, often at a later stage than usual.
The scissors gait, which arises from bilateral spastic paresis (diplegia), impacts both legs and has minimal or no impact on the arms. The patient exhibits partial flexion of the legs at the hips and knees, giving the impression of squatting. With every stride, his thighs contract and his knees strike or intersect in a sharp, slicing motion.
His strides are brief, consistent, and arduous, as if he were deftly navigating through water up to his waist. The patient's feet exhibit plantar flexion and inward turning, accompanied by a shortened Achilles tendon. Consequently, he walks on his toes or on the balls of his feet, potentially causing scraping of his toes on the ground.
Histories and Physical Assessment
Prompt the patient (or a family member, if the patient is unable to respond) regarding the beginning and length of the walking pattern. Has it exhibited sequential deterioration or maintained a stable state? Request information regarding a past record of trauma, encompassing birth trauma, as well as neurological problems. Evaluate motor and sensory function, as well as deep tendon reflexes (DTRs), in the legs comprehensively.
Medical etiology
Cerebral palsy
Individuals with the spastic variant of cerebral palsy exhibit a scissors gait when walking on their toes. Additional characteristics include heightened activation of deep tissue receptors (DTRs), heightened stretch reflexes, fast and alternating contraction and relaxation of muscles, muscular weakness, underdevelopment of the affected limbs, and a propensity for contractures.
Cervical spondylosis with myelopathy
Scissors gait emerges during the advanced phases of cervical spondylosis accompanied by myelopathy and progressively deteriorates thereafter. Corresponding symptoms resemble those of a herniated disk: intense lumbar pain that can extend to the buttocks, legs, and feet; muscular spasms; loss of sensory perception; and muscular weakness and wasting.
Multiple sclerosis (MS)
Typically, progressive scissors gait progresses gradually, with occasional remissions. Distinctive muscular weakness, often in the legs, varies from little fatigue to paraparesis accompanied by urine urgency and constipation. Additional diagnostic features encompass face pain, visual impairments, paresthesia, lack of coordination, and diminished proprioception and vibration perception in the ankle and toes.
Spinal cord tumor
Scissors gait may progress gradually from a tumor located in the thoracic or lumbar region. Additional symptoms indicate the specific site of the tumor and may encompass pain in the radicular, subscapular, shoulder, groin, leg, or flank regions; muscle spasms or fasciculations; muscle atrophy; sensory impairments, such as paresthesia and a girdle sensation in the abdomen and chest; hyperactive ductal tunnel receptors; a bilateral Babinski's reflex; spastic neurogenic bladder; and sexual dysfunction.
Syringomyelia
Scissors gait often manifests relatively late in syringomyelia, accompanied by analgesia and thermanesthesia, muscular atrophy and weakening, and the presence of Charcot's joints. Additional consequences may encompass the detachment of fingernails, fingers, or toes; Dupuytren's contracture of the palms; deviation from normal spinal alignment; and clubfoot. Skin in the afflicted regions often exhibits dryness, scaliness, and grooves.
Key Factors to Consider
Administer thorough skin care to avoid skin breakdown and the development of pressure ulcers due to the sensory loss caused by scissors gait. Furthermore, provide the patient and his family with comprehensive guidelines for skin care. If deemed suitable, proceed with bladder and bowel retraining.
Incorporate daily regimens of both active and passive range-of-motion exercises. Consultation with a physical therapist may be necessary for gait retraining and other in-shoe modifications.
Application of splints or leg braces to ensure correct foot alignment during standing and walking.
Therapeutic Counseling for Patients
Provide the patient and his family with comprehensive guidance on skin care. If deemed suitable, educate them on bladder and bowel retraining. Emphasise the correct application of splints or braces, if suitable.
Guidelines for Pediatric Populations
Primary etiologies of scissors gait in children include cerebral palsy, inherited spastic paraplegia, and congenital spinal damage. The presence of spastic paraplegia at birth results in the manifestation of scissors gait when the infant starts walking, often at a later stage than usual.
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