Gait Disorders: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; furthermore:
  • Inspection (viewing).
    • Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes.
    • Gait (fluid, limping) or examination of gait and balance:
      • Romberg standing test (synonyms: Romberg test; Romberg test) – The Romberg standing test is used as a clinical test to investigate ataxia (vestibular, spinal (spinal cord), or cerebellar (cerebellum)) and can help differentiate between spinal (“spinal cord-related”) and cerebellar (“cerebellum-related”) ataxia (disorders of movement coordination). To perform the test, the patient is asked to stand with his feet close together and his arms stretched out in front of him, and to close his eyelids. A positive finding (= positive Romberg sign) indicates a deterioration in coordination due to closure of the eyelids. A sign of deterioration is an increasing swaying, which would be indicative of spinal ataxia. A negative finding indicates unchanged coordination after eye closure.
        • If the patient can control sway only incompletely or not at all, even with eyes open, this is indicative of cerebellar ataxia.
        • A tendency to fall in one direction after eye closure would speak for damage to the respective vestibular organ (organ of balance).
    • Body or joint posture (upright, bent, gentle posture).
    • Malpositions (deformities, contractures, shortenings).
    • Muscle atrophies (side comparison!, if necessary circumference measurements).
    • Joint (abrasions/wounds, swelling (tumor), redness (rubor), hyperthermia (calor); injury indications such as hematoma formation, arthritic joint lumpiness, leg axis assessment).
  • Palpation (palpation) of vertebral bodies, tendons, ligaments; musculature (tone, tenderness, contractures of paraverebral muscles); soft tissue swelling; tenderness (localization! ); restricted mobility (spinal movement restrictions); “tapping signs” (testing for painfulness of spinous processes, transverse processes, and costotransverse joints (vertebral-rib joints) and back muscles); illiosacral joints (sacroiliac joint) (pressure and tapping pain? ; compression pain, anterior, lateral or saggital); hyper- or hypomobility?
  • If necessary, palpation of prominent bone points, tendons, ligaments; musculature; joint (joint effusion? ); soft tissue swelling; pressure pain (localization!).
  • If necessary, measurement of joint mobility and range of motion of the joint (according to the neutral zero method: the range of motion is given as the maximum deflection of the joint from the neutral position in angular degrees, where the neutral position is designated as 0°. The starting position is the “neutral position”: the person stands upright with the arms hanging down and relaxed, the thumbs pointing forward and the feet parallel. The adjacent angles are defined as the zero position. Standard is that the value away from the body is given first). Comparative measurements with the contralateral joint (side comparison) can reveal even small lateral differences.
  • If necessary, special functional tests depending on the affected joint.
  • Auscultation (listening) of the heart
  • Palpation of the abdomen (abdomen), etc.
• Ophthalmic examination – including visual acuity check [visual acuity reduction].
• Neurological examination – including testing of reflexes, gait/standing tests, extremity/oculomotor testing [see under differential diagnoses: nervous system].
• Psychiatric examination [wg.Differential diagnoses: anxiety/phobia, dementia, depression]

Common gait disorders and their etiology

Square brackets [ ] indicate possible pathological (pathological) physical findings.