The "Medical Street game" - Part 1

We walk the streets almost every single day of our lives. We travel back and forth in buses, trains and taxis. Yet we fail to practice a key skill of diagnosis - "observation" during this walking and travelling.

Medicine is an art and it is fun when you get the picture right the first time. This post is to help us remember to observe and hopefully get the diagnosis right the first time.

Let us call this the "Medical Street game." Today let's learn to diagnose diseases based on gait the patient exhibits.

I am a fan of House MD series. Largely due to the drama (emotions) that prevails in the series that we so much lack in our everyday lives as doctors. Accompanying this drama is the kinetics in the series .i.e. the main characters in the series walk for almost 10% of an episode. This got me thinking about the gait that Dr. House has.


On analysis I found that he has an atypical pathological gait because he uses the cane in the wrong side.

Had he used the cane at the right side i.e., the left side then we could describe his walk as "Hemiplegic gait". Anyone with unilateral lower limb weakness is prone to have this type of gait (most commonly in Stroke).

Affected lower limb may showcase the following characteristics:
Arm: flexed, adducted and internally rotated.
Leg: extension and circumduction
Foot and toes: plantar flexion, foot drop and extensor hypertonia in lower limb.

A patient with bilateral lower limb weakness has "Diplegic gait", aka Scissor gait which is most commonly seen in Cerebral palsy. The patient typically drags his legs while walking.

Hypothetical question: If a patient with Parkinson's disease (Parkinsonian gait) was to race with a patient with diabetic neuropathy (High steppage gait), who do you think will win?

Both of them have equal chances of winning.

If the former is the winner, it would probably be because of progressive increase of speed in Parkinsonian gait.
If its the latter then it would probably be because of tiny steps taken in the former case.

Which type of gait resembles an alcoholic's gait? It is the Ataxic gait.

This is commonly seen in patients with Cerebellar disorders. The gait is described as unsteady with clumsy movements.

Another example for an unsteady gait is Choreiform gait which is seen in basal ganglia disorders. Additionally these patients also have involuntary, jerky movements.

When a supermodel sways her hips from one side to another, it is termed sexy. But if the sway stays in one side, it's called Trendelenburg sign. This sign is seen when unilateral hip muscles are weak.

These are few of the disorders that can be suspected by merely observing the patient's gait. There are a lot other observational techniques that can aid in diagnosing various diseases. I shall work on those in the weeks ahead.