What Doctors Notice Just From Your Walk - Knee Exam

Hello, my name is Dr James Gill and we're going to break down a few of the subtle aspects of the knee exam. When it comes to looking at a patient's gait, we want to both visually pay attention and also have a listen. So for example, when the patient is walking, in terms of listening, we might see evidence of a high stepping gait if we hear the slapping sound of that foot being raised and coming down with a much firmer impact than we have on the other side. Now that doesn't necessarily mean that there's a problem with the knee. We may have an issue with proprioception or perhaps diabetic neuropathy, i.e. with these the patient isn't quite aware of where the knee is in terms of relation to their other joints. So by striking the floor with that much increased force, they're getting some additional information with regard to the vibration sense. Now that's a point because those increased impacts all the while may be a source of discomfort to that knee in itself. In terms of looking at the patient's gait, we want to have them walk five paces forward, turn and come back, almost as if they're on the catwalk. The reason for that being is we want to get them to engage with their normal gait pattern. And it'll normally take about five steps before somebody starts actually just walking rather than thinking about pacing. So we get a natural appearance of their gait. At that point, we're also going to look to see if there is an antalgic gait, basically a fancy name for is the patient limping due to pain. And we get what's called a dot-dash gait. Whenever the patient is standing on the non-painful leg, they'll put a lot more weight and time on that. Conversely, when they go on the painful leg, they're going to jump off that leg as quickly as they can, i.e. reducing the time on it. We might also, if the patient's got a hip problem, see a Trendelenburg gait, whereby the patient's hip will drop down on the contralateral side, i.e. the unaffected leg. Now to be fair, that's a weakness to the hip muscles, particularly the gluteus medius, but it's important when we're assessing any joint that we look at the joint above and below. So although the patient has said they have knee pain, if we see a Trendelenburg gait, that might mean we need to look a little bit higher. If this has been beneficial, follow along for more clinical examination pearls. Take care, and we'll see you in the next one. Cheerio.