Gait Analysis — MCQs
In walking, gravity tends to tilt pelvis and trunk to the unsupported side, the major factor in preventing this unwanted movement is?
What do muscle spindles primarily detect?
What is the condition commonly known as jumper's knee?
The kinetic energy of the body is least in one of the following phases of the walking cycle
High stepping gait is due to
Lurching Gait is due to paralysis of which of the following?
Unilateral high stepping gait is seen in
What condition is characterized by a waddling gait?
The following gait is seen due to weakness of:
Trendelenburg's sign is positive in injury to which structure?
Gait Analysis Indian Medical PG Practice Questions and MCQs
Question 1: In walking, gravity tends to tilt pelvis and trunk to the unsupported side, the major factor in preventing this unwanted movement is?
- A. Adductor muscles
- B. Quadriceps
- C. Gluteus medius and minimus (Correct Answer)
- D. Gluteus maximus
Explanation: ***Gluteus medius and minimus*** - The **gluteus medius** and **gluteus minimus** are essential **abductors** of the hip, primarily responsible for stabilizing the pelvis during the **single-limb support phase of gait**. - When one leg is lifted during walking, these muscles on the **stance leg side** contract to prevent the pelvis from tilting downwards on the unsupported swing leg side. *Adductor muscles* - **Adductor muscles** (adductor longus, brevis, magnus, pectineus, gracilis) primarily function to bring the thigh toward the midline of the body. - While they play a role in gait stability, their main action is not to prevent the lateral pelvic tilt described. *Quadriceps* - The quadriceps femoris group (rectus femoris, vastus lateralis, medialis, intermedius) are powerful **extensors of the knee**. - They are crucial for weight acceptance and propulsion during walking but do not directly prevent lateral pelvic tilt [1]. *Gluteus maximus* - The **gluteus maximus** is the largest and most powerful muscle of the hip, primarily responsible for **hip extension** and **external rotation**. - It is crucial for activities like climbing stairs or running, but its main role in normal walking is not to prevent lateral pelvic tilt; that function is more specific to the gluteus medius and minimus.
Question 2: What do muscle spindles primarily detect?
- A. Joint position changes
- B. Muscle tension changes
- C. Muscle length changes (Correct Answer)
- D. Muscle velocity changes
Explanation: ***Muscle length changes*** - **Muscle spindles** are specialized **stretch receptors** located within the muscle belly. - Their primary function is to detect the **rate of change in muscle length** and the absolute muscle length. *Muscle tension changes* - **Golgi tendon organs (GTOs)**, not muscle spindles, are responsible for detecting changes in **muscle tension**. - GTOs are located in the **tendons** and provide information about the force generated by muscle contraction. *Joint position changes* - While muscle spindles indirectly contribute to **proprioception** (sense of joint position), other **mechanoreceptors** like **Ruffini endings** and **Pacinian corpuscles** in joint capsules and ligaments are more directly involved in sensing joint position. - Muscle length changes are distinct from overall joint position, though related. *Muscle velocity changes* - While muscle spindles do detect the **rate of change** of muscle length, which relates to velocity, their primary role encompasses both static length and dynamic changes. - The most direct and comprehensive descriptor of their main function is detecting "muscle length changes."
Question 3: What is the condition commonly known as jumper's knee?
- A. Inflammation of the patellar tendon at its insertion on the patella.
- B. Tendinopathy of the quadriceps tendon.
- C. Injury to the hamstring tendon.
- D. Patellar tendonitis due to overuse of the patellar tendon. (Correct Answer)
Explanation: ***Patellar tendonitis due to overuse of the patellar tendon.*** - **Jumper's knee** is the common term for **patellar tendonitis**, which specifically refers to inflammation of the patellar tendon. - This condition is frequently caused by **overuse**, especially in activities involving repetitive jumping and landing. *Inflammation of the patellar tendon at its insertion on the patella.* - While jumper's knee does involve inflammation of the patellar tendon, it is more commonly at its insertion on the **tibial tubercle** or specifically its origin at the **inferior pole of the patella**, not necessarily at the patella itself. - This option is less precise as it describes only one aspect of the condition without mentioning the critical role of overuse. *Tendinopathy of the quadriceps tendon.* - **Tendinopathy of the quadriceps tendon** is a distinct condition affecting the tendon above the patella, known as **quadriceps tendinopathy**. - It presents with pain proximal to the patella, differentiating it from jumper's knee, which involves the tendon distal to the patella. *Injury to the hamstring tendon.* - An **injury to the hamstring tendon** would cause pain and symptoms on the posterior aspect of the knee or thigh. - This is completely unrelated to jumper's knee, which is characterized by anterior knee pain.
Question 4: The kinetic energy of the body is least in one of the following phases of the walking cycle
- A. Double support
- B. Mid-stance (Correct Answer)
- C. Toe-off
- D. Heel strike
Explanation: ***Mid-stance*** - During **mid-stance**, the body's center of gravity is at its **highest point**, and the vertical velocity is near zero as the body transitions from upward to downward motion, contributing to **reduced kinetic energy**. - At this phase, forward velocity is relatively constant but the body is at the apex of its vertical trajectory, representing a point of **minimal total kinetic energy** in the sagittal plane. - The body transitions from deceleration to acceleration, with the limb providing stable support as weight passes over the stance foot. *Double support* - In **double support**, both feet are on the ground during the weight transfer phase, and the body's center of gravity is at a lower position compared to mid-stance. - While some energy is dissipated during weight transfer, this phase involves active muscular work and forward momentum maintenance, with kinetic energy being variable. - This represents a transition phase between single support periods, with complex energy exchanges occurring. *Toe-off* - At **toe-off**, the propulsive phase of gait, the body is generating forward momentum with peak forward velocity, meaning there is **significant kinetic energy** as the foot pushes off the ground. - The body's center of gravity is moving upwards and forwards, indicating a higher kinetic energy state. - Ankle plantarflexors are actively propelling the body forward, maximizing kinetic energy output. *Heel strike* - **Heel strike** is a moment of initial contact where the body's forward velocity is still considerable, possessing **significant kinetic energy**. - The limb is preparing to absorb impact forces while the body's center of mass continues moving forward, representing high kinetic energy just before the deceleration phase. - This marks the beginning of the stance phase with substantial horizontal velocity maintained from the swing phase.
Question 5: High stepping gait is due to
- A. Gluteus maximum paralysis
- B. CDH
- C. Quadriceps paralysis
- D. Foot drop (Correct Answer)
Explanation: ***Foot drop*** - **Foot drop** causes the patient to lift the leg higher during walking to prevent the toes from dragging on the ground, resulting in a **high stepping gait**. - This condition is often due to weakness or paralysis of the **dorsiflexor muscles** of the foot, typically from **peroneal nerve injury** or **L4/L5 radiculopathy**. *Gluteus maximum paralysis* - **Gluteus maximus paralysis** causes difficulty with hip extension and is often compensated by a **backward lurch** of the trunk during gait. - It results in a **Trendelenburg gait** (if the gluteus medius is also affected) or instability during standing, but not typically a high stepping gait. *CDH* - **Congenital hip dysplasia (CDH)** involves abnormal development of the hip joint. - It usually leads to a **waddling gait** due to instability and pain, or limb length discrepancy, not a high stepping gait. *Quadriceps paralysis* - **Quadriceps paralysis** results in weakness or inability to extend the knee. - Patients typically compensate by hyperextending the knee or leaning forward over the affected leg during gait, which is not a high stepping gait.
Question 6: Lurching Gait is due to paralysis of which of the following?
- A. Gluteus medius (Correct Answer)
- B. Adductor magnus
- C. Hamstrings
- D. Quadriceps femoris
Explanation: ***Gluteus medius*** * Paralysis of the **gluteus medius** leads to a **Trendelenburg gait** or **lurching gait**, where the pelvis drops on the unsupported side during walking. * This muscle is crucial for **stabilizing the pelvis** during the single-limb support phase of gait. *Adductor Magnus* * Paralysis of the adductor magnus would primarily affect **thigh adduction** and extension, not directly causing a lurching gait. * Problems with this muscle might impact the ability to bring the legs together or stabilize the leg during certain movements. *Hamstrings* * The hamstrings are responsible for **knee flexion** and **hip extension**. * Paralysis would result in difficulty bending the knee and limited hip extension, potentially leading to a stiff-knee gait, but not typically a lurching gait. *Quadriceps femoris* * The quadriceps femoris is essential for **knee extension** and is critical for activities like standing, walking, and climbing stairs. * Paralysis would cause the knee to buckle, leading to a **knee-hyperflexion gait** or difficulty with weight-bearing on that leg.
Question 7: Unilateral high stepping gait is seen in
- A. Distal radiculopathy
- B. Cauda equina syndrome
- C. L5 radiculopathy (Correct Answer)
- D. None of the options
Explanation: ***L5 radiculopathy*** - Damage to the **L5 nerve root** can cause weakness in the **tibialis anterior muscle**, leading to **foot drop**. [1] - To compensate for the foot drop and prevent tripping, the patient develops a **high stepping gait** (steppage gait) on the affected side. [1] *Distal radiculopathy* - This term is too general; **radiculopathy** refers to nerve root compression but does not specify which root or its precise distal effects. - While a radiculopathy can cause weakness, "distal" does not specifically localize to L5 or unilateral foot drop. *Cauda equina syndrome* - This is a serious condition involving **compression of multiple nerve roots** below the conus medullaris. - It typically causes bilateral symptoms, including **saddle anesthesia**, bowel/bladder dysfunction, and often bilateral leg weakness, not isolated unilateral foot drop. *None of the options* - This option is incorrect because **L5 radiculopathy** directly explains unilateral high stepping gait due to foot drop.
Question 8: What condition is characterized by a waddling gait?
- A. Bilateral congenital dysplasia of hip (Correct Answer)
- B. Coxa valga
- C. CTEV
- D. Muscular dystrophy
Explanation: ***Bilateral congenital dysplasia of hip*** - A **waddling gait**, also known as a **Trendelenburg gait**, occurs due to weakness of the hip abductor muscles (gluteus medius and minimus) on both sides. - In bilateral congenital dysplasia of the hip, the **femoral heads are poorly seated** or dislocated, leading to ineffective abductor function and the characteristic gait. *Coxa valga* - This condition involves an **increased angle** between the femoral neck and shaft, which can alter biomechanics but does not typically cause a waddling gait in isolation. - While it can be associated with other hip pathologies, **coxa valga itself is not the primary cause** of a waddling gait. *CTEV* - **CTEV (Congenital Talipes Equinovarus)**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It affects the patient's ability to walk normally, but results in a different type of gait abnormality, typically involving limping or walking on the outer edge of the foot, **not a waddling gait**. *Muscular dystrophy* - While many forms of muscular dystrophy can lead to a waddling gait due to **proximal muscle weakness**, it is a broad category of genetic disorders. - Without further context or specific type of muscular dystrophy, **bilateral congenital hip dysplasia is a more direct and specific cause** for the symptom described.
Question 9: The following gait is seen due to weakness of:
- A. Gluteus maximus
- B. Gluteus medius (Correct Answer)
- C. Psoas major
- D. Tibialis anterior
Explanation: ***Gluteus medius*** - Weakness of the **gluteus medius** leads to a **Trendelenburg gait**, where the pelvis drops on the unsupported side during the swing phase of gait. - The image suggests pelvic tilting, which is characteristic of the body attempting to compensate for the inability of the gluteus medius to stabilize the pelvis. *Gluteus maximus* - Weakness of the gluteus maximus causes difficulty in **hip extension**, resulting in a **lurching gait** where the trunk is thrown backward at heel strike. - This is commonly known as a **gluteus maximus lurch**, which is not depicted in an obvious manner here. *Psoas major* - Weakness of the psoas major would primarily affect **hip flexion**, making it difficult to lift the leg off the ground (e.g., during the swing phase). - This would result in compensatory movements such as circumduction or hiking the hip, rather than the characteristic pelvic drop. *Tibialis anterior* - Weakness of the tibialis anterior causes **foot drop**, leading to a **steppage gait** where the knee is lifted high to avoid dragging the foot. - The image does not show a foot drop or high stepping, thus ruling out tibialis anterior weakness.
Question 10: Trendelenburg's sign is positive in injury to which structure?
- A. Gluteus maximus
- B. Gluteus medius (Correct Answer)
- C. Quadriceps femoris
- D. Quadratus lumborum
Explanation: ***Gluteus medius*** - A positive **Trendelenburg's sign** indicates weakness or paralysis of the **gluteus medius** muscle, or problem with its innervation or hip joint. - This muscle is crucial for **abduction** and **stabilization** of the pelvis during gait; its dysfunction causes the unsupported side of the pelvis to drop. *Gluteus maximus* - The **gluteus maximus** is primarily involved in **hip extension** and external rotation, not hip abduction or pelvic stability during single-leg stance. - Weakness in this muscle would manifest more as difficulty with climbing stairs or rising from a seated position. *Quadriceps femoris* - The **quadriceps femoris** muscles are responsible for **knee extension**, essential for walking and standing. - Injury to these muscles would primarily affect the ability to **straighten the leg** and bear weight on it, not cause pelvic drop. *Quadratus lumborum* - The **quadratus lumborum** is a deep abdominal muscle involved in **lateral flexion of the trunk** and stabilization of the lumbar spine. - Dysfunction of this muscle would lead to **trunk instability** or pain, but not the specific pelvic drop seen in Trendelenburg's sign.
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