Limp

Claudication ( colloquially: limp; obsolete: lame; Latin: claudication / limp; Latin: Claudian care / lag ) is a deviation from the normal course, a form of unilateral or bilateral gait disturbance, an asymmetry of the Ganges in its distance and time factors ( spatial and temporal asymmetry). Through disruption pelvis-leg static gait acts abnormal and pathological changes, asymmetric and frail. When walking, the change between the stance and swing phase is disturbed. Walking ability is retained, but limited.

The two-sided claudication leads to waddle (Latin vacillatio, claudicatio anatica ), such as two-sided Trendelenburg limp (see below ), the pelvis tilts at every step to the side.

The limp may be temporarily or permanently. Depending on the different causes of lameness is divided into various shapes, the various forms of claudication often occur as a mixed form:

• Shortening claudication
• Claudication pain
• Stiffening claudication
• Limp paralysis
• The limp static and dynamic instability
• Limping in neuromuscular incoordination
• Trendelenburg limp ( Hüfthinken )
• Intermittent claudication
• Psychogenic claudication

• 6.1 of Hüfthinkens diagnosis
• 6.2 Causes of the Hüfthinken
• 6.3 Oberschenkelabduktoren
• 6.4 Hüfthinken with hip osteoarthritis

General characteristics of the limp

In particular, the two-legged walking is characterized by concerted vibrations of various body parts, both in normal as well as the limp. In this kinematic chain there is co-movement of the trunk and upper extremities ( Armpendel ). The pendulum behavior of the individual parts, within the meaning of backstop mechanisms is important for the harmonious flow of the Ganges as an energy- saving movement.

With unilateral claudication the symmetry of the step image is disturbed and there is a umgleichmäßiges increment and / or an abnormal step rhythm. In this form of walking the sequence of steps is not carried out uniformly and regularly, it results in a discordant asymmetrical gait, movement and stride length are no longer symmetrical, the weight distribution is different from the norm. One leg is faster than the other leg while walking.

Mary Murray described 1967, the space / time parameters of the course of Hüftkranken detail when claudication:

• Reduced walking speed,
• Prolonged duration of the double stance phase
• Prolonged stance phase duration of the healthy leg
• Increased movement of the trunk and the head
• Decreased step length when the affected leg step cycle begins (extension inhibition)
• Increased pelvic movement
• Decreased motion amplitudes of both the hips and the knees
• Increased elbow flexion in the swing phase
• Decreased step frequency
• Moving the upper body to the side of the stand

Modern methods for gait analysis are:

• Filming at three levels
• Chronozyklografie ( photograph with multiple exposures)
• Light -track recordings
• Measurement of the ground contact and the force acting on the ground
• Registration of joint position, velocity and acceleration of the body parts
• Measurement of muscle activity during walking ( electromyography )

Shortening claudication

The shortening claudication is caused by anatomic or functional short leg and is accompanied by a misalignment of the pelvis. Triggering causes are differences in leg length, unilateral reduction of the charge of the knee and hip flexion muscles or shortened adductors. The reductions can be made near the joint or peripheral portion of a leg.

The shortening of claudication may be the first symptom of a leg length difference or a unilateral angular deformity, such as genu varum deformity, be.

Such unilateral leg shortening occur, for example in hip osteoarthritis, hip dysplasia, or as a result of poliomyelitis. Even after not really healed femoral neck fractures can occur as a result of varus deformity of the femoral neck in leg length.

A hip flexion or Hüftanspreizkontraktur lead to functional shortening of the leg, while a Hüftabspreizkontraktur leads to a functional leg extension.

The shortening limp is only noticeable when walking, but not on one leg ( pelvic position ). When shortening limp, the body center of gravity lowers while walking, during short-term stance on the shortened leg, excessively off and the center of gravity is shifted to balance the weight on the relatively longer leg.

An equinus leads to functional leg extension and thus to shorten limp. By the same mechanism of congenital clubfoot or Having had polio lead to shortening limp.

To compensate for the reduction of claudication, the persons concerned shall seek the leg lengths of the two sides equal to each other. To this end, she goes with the shorter leg in the toe stand or with the longer leg slightly bent knee and hip, also can both compensation mechanisms are used simultaneously.

The Limping Devil, which is represented by one or two goat or horse feet, is also to be interpreted as shortening limp.

Treatment of Verkürzungehinkens

The aim of the treatment is a balancing of the leg lengths by surgical limb lengthening, which can be done up to 20 cm, or a shoe increase ( Orthopädieschuhmacher; leg extension compensation for walking and standing ). However, the compensation of orthopedic shoes often leads to functional and cosmetic impairments.

Among the surgical methods of leg lengthening include:

• External fixator (outer tensioner ) for callus distraction (obsolete )
• Lengthening intramedullary nail ( nail extension ) ISKD nail ( Intramedullary Skeletal Kinetic Distractor; )
• Albizzia nail
• Fitbone

In naturopathy and the manual leg length compensation is propagated, wherein the treatment is focused on the longer leg, which is identified as the most extended morbid.

Claudication pain

The so-called pain limp or limping is a result of painful disorders or trauma to the leg (eg knee joint ), foot (eg, ankle or Achilles tendon), hip or sacroiliac joints. One-sided hip pain can for example be caused by contusion, coxitis ( hip inflammation), femoral head necrosis or hip osteoarthritis.

Due to the short -term cautious burden of the painful standing leg because of the burden pain shows an unbalanced ( unrhythmical ), almost " choppy " gait to a leg by weight relief conserve ( posture by relieving limp with shortened stance phase on the affected leg; painful occurrence ), with this step is then carried out quickly in order to shorten the loading time, and to charge only partially to the painful leg ( part load). For pain reduction, the foot is only partially or not at all unrolled in some cases. For example, a powerful movement of the foot and the toe is no longer possible with discomfort in the Achilles tendon. The rejection of the foot from the ground is slowed down to avoid load peaks. Especially with only mild pain or pain on both sides of the foot might be placed just gently and slowly to the ground. Only painful parts of the walking motion may be reduced - for example, in the first metatarsophalangeal joint osteoarthritis or hallux rigidus.

In order to reduce the torque of the hip abductor muscles by shortening of the load arm is displaced when claudication pain of the upper body and let the body focus on the standing leg. The pelvic and thigh pain during movement is limping through the tilt of the lumbar spine.

Such pain can be caused by tendinitis, had moved to injury or age-related joint deterioration, but also quite simple causes, such as inappropriate footwear.

The concept of avoiding pain claudication (English " Antalgic gait ") was coined in 1939 by Jacques Calvé when he described the limp with hip pain ( Coxalgien ).

Stiffening claudication

When stiffening claudication is a Hüftversteifung, ie restriction of movement in the hip joint, responsible for ensuring that there is a concomitant movement of the pelvis during the swing phase of gait. In contrast to other types of claudication occur not to a decrease in the pool.

Through the stiffening of the hip joint the leg can not swing freely when walking forwards, but the swinging of the leg is effected by rotation of the entire basin. You may be the center of gravity is additionally lifted by a slight toe stand is made on the healthy side.

Even with joint stiffness in the knee or ankle results in a limping gait.

When reinforcements in the knee joint, the hip joint is a compensatory increased sharply and then swinging the leg in a lateral outer arc ( circumduction ) forward.

For stiffeners of the ankles and the occurrence of rolling is disturbed.

Limp paralysis

The limp paralysis occurs with partial or total flaccid paralysis. Instead of paralysis limp is sometimes spoken of " Limping in spastic paralysis and incoordination ."

For limp paralysis include spastic gait disorders for which the consequences of polio or even in certain spinal cord lesions may be the cause, as well as hemiplegic gait disorders due to incomplete paralysis of peripheral nerves.

Another form of paralysis claudication is the stepper gear ratio which is usually caused by a peroneal paralysis ( paralysis of Fußhebers ). Here, the big toe is placed chronologically before the heel.

When limp paralysis often occur compensatory increased action of other muscle groups.

Hüfthinken

The Hüfthinken occurs at a insufficiency of the middle gluteal muscle ( gluteus medius ) and the small gluteal muscles ( gluteus minimus ) to ( insufficiency claudication ). Thus the basin decreases in the stance phase to the opposite side, while lateral flexion of the trunk to the ( affected ) leg.

When Hüfthinken or insufficiency claudication is a static or dynamic instability of the pelvis (anatomy). The Hüfthinken is also called a Trendelenburg gait, Trendelenburg limp, Duchenne limp or as Trendelenburg Duchenne limp. It is caused by a weakness or paralysis of the Oberschenkelabduktoren.

Diagnosis of Hüfthinkens

When Trendelenburg limp, in the short period of one leg on the affected leg, the pelvis tilts from the non-affected side of the swing leg. The reason for this is a strong impairment of Oberschenkelabduktoren. These will keep in the healthy in the phase of one leg the pelvis in the horizontal position. Since the tilting of the pelvis without technical aids for recording the Trendelenburg limp difficult to see, the doctor uses in the diagnosis back to the examination of the patient in a standing position. The besides, popular Trendelenburg sign while standing is the static equivalent of the Trendelenburg limp while walking ( dynamic study ).

The Trendelenburg 's sign is positive when it comes to lowering of the healthy leg side when standing on the affected leg ( one leg stance ), while the patient raises the diffracted in hip and knee healthy leg on something. Or in other words: the Trendelenburg 's sign is positive when the sweeping side hip is not raised; or: under load the pelvis drops to the opposite side.

In contrast, when standing on the unaffected leg, the pelvis are held in a horizontal position. The lowering of the pelvis when standing on the affected side indicates a weakness of the gluteus medius and gluteus minimus of.

Friedrich Trendelenburg found in 1895 that the gluteus medius is the most important muscle, the weakness triggers the Hüfthinken.

In 1865 the Guillaume- Benjamin Duchenne had described the Hüfthinken, in a comparative study between the forms of claudication at a weakness of the abductors and the limp in paralysis.

Named after him Duchenne characters: When single-leg stance on the affected leg, the upper body is shifted to the leg side. Although Duchenne described the Hüfthinken 10 years ago Trendelenburg, is named after him Duchenne characters ( Oberkörperseitneigung ) refers to a compensatory action sequence on the Trendelenburg sign ( tilting of the pelvis ).

Or in other words: To avoid the tipping of the pelvis on the side of the swing leg ( Trendelenburg sign ) the focus by Hinüber own body ( Duchenne 's sign) is slightly shifted. But this only occurs when one-legged stance on the affected side.

The dynamic equivalent of the ( static ) Duchenne character is the Duchenne limp ( Duchenne -course ): This comes while walking to an increased Rumpfauslenkung the affected leg side to compensate for the Hüftabduktoreninsuffizienzen.

A positive Duchenne characters ( Oberkörperseitneigung ) can compensate for a weak Trendelenburg sign and thereby mask and let go undetected. By sweeping -like Zurseiteneigen the trunk towards the affected side when loading the Trendelenburg sign is prevented.

Calvé different in 1939 when Hüfthinken between ( pain- related ) analgischem Hüfthinken and limp through glute medius - insufficiency. By Hüfthinken required for walking muscle force is reduced, consequently, therefore, only a smaller force must also act on the hip joint during walking and a painful joint is spared ( pain- contingent Hüfthinken ).

Reasons for Hüfthinken

The cause of the muscle insufficiency ( disorder of musculus gluteus function) are hip joint diseases, such as childhood hip dysplasia ( flattening of the acetabulum ), hip dislocation or coxa vara (shortened femoral neck angle), pseudoarthrosis, muscular dystrophy, coxa vara ( Schenkelhalsverbiegung with Fehlinsertion the muscles and thus unfavorable lever arm; eg Trochanterhochstand ).

Since these muscle insufficiency often occurs on both sides, then it comes to a double-sided limp - the waddle. For the Hüfthinken the watschelndes gait is typical.

A possible treatment of choice when Hüfthinken is the Trochanterversetzung.

Oberschenkelabduktoren

The Oberschenkelabduktoren ( Beinabspreizer ) cause the abduction (abduction ) of the leg to the outside. Correct, one should speak of the Hüftgelenksabduktoren, instead of the Oberschenkelabduktoren. The following muscles belong to this group of muscles:

• Gluteus medius
• Gluteus minimus
• Gluteus maximus ( cranial part )
• Tensor fasciae latae
• Piriformis muscle
• Sartorius muscle

Of these muscles, only a part of the latter, the sartorius muscle, the thigh muscles. The first five muscles belong to the rear or deep layer of the hip muscles. During walking and running the Beinabduktoren ensure that at each step the pelvis is balanced.

The main Oberschenkelabduktoren are musculus gluteus medius and gluteus minimus, gluteus maximus during and tensor fasciae latae act only in addition.

Since the lever arm of the body burden in the state of something is three times as long as the lever arm of the abductors, their muscle strength during one-legged stance must correspond to about three times the body weight.

Hüfthinken with hip osteoarthritis

Limping with hip osteoarthritis is a Gentle, shortening or Hüfthinken.

In the hip joint osteoarthritis ( coxarthrosis ) the Oberschenkelabduktoren can be weakened for two reasons:

Intermittent claudication

Main article: intermittent claudication

Intermittent claudication (Latin: intermittens / temporary ) may occur on the floor of arterial occlusive disease: due to arterial circulation disorders (peripheral arterial occlusive disease), which then lead to spasmodic calf pain and trigger the limp.

From the intermittent claudication the much rarer claudication must be distinguished intermittens spinalis. Here come the pain and the accompanying claudication due to spinal stenosis typically when walking up and down and let in after walking breaks.

Also, a circulatory disorder of the intestinal wall - with abdominal angina may cause intermittent claudication - intermittent claudication abdominalis.

Psychogenic or hysterical claudication

Trigger for the psychogenic claudication are psychological factors in the first place. It is a painless, " voluntary " limp.