Gait, scissors

Resulting from bilateral spastic paresis (diplegia), scissors gait affects both legs and has little or no effect on the arms. The patient’s legs flex slightly at the hips and knees, so he looks as if he’s crouching. With each step, his thighs adduct and his knees bump together or cross in a scissorslike movement. (See Identifying gait abnormalities, pages 358 and 359.) His steps are short, regular, and laborious, as if he were wading through waist-deep water. His feet may be plantarflexed and turned inward, with a shortened Achilles tendon; as a result, he walks on his toes or on the balls of his feet and may scrape his toes on the ground.

History and physical examination

Ask the patient (or a family member if the patient can’t answer) about the onset and duration of the gait. Has it progressively worsened or remained constant? Ask about a history of trauma, including birth trauma, and neurologic disorders. Thoroughly evaluate motor and sensory function and deep tendon reflexes (DTRs) in the legs.

Medical causes

Cerebral palsy

In the spastic form of this disorder, patients walk on their toes with a scissors gait. Other features include hyperactive DTRs, increased stretch reflexes, rapid alternating muscle contraction and relaxation, muscle weakness, underdevelopment of affected limbs, and a tendency toward contractures.

Cervical spondylosis with myelopathy

Scissors gait develops in the late stages of this degenerative disease and steadily worsens. Related findings mimic those of a herniated disk: severe low back pain, which may radiate to the buttocks, legs, and feet; muscle spasms; sensorimotor loss; and muscle weakness and atrophy.

Hepatic failure

Scissors gait may appear several months before the onset of hepatic failure. Other findings may include asterixis, generalized seizures, jaundice, purpura, dementia, and fetor hepaticus.

Multiple sclerosis

Progressive scissors gait usually develops gradually, with periodic remissions. Characteristic muscle weakness, usually in the legs, ranges from minor fatigability to paraparesis with urinary urgency and constipation. Related findings include facial pain, visual disturbances, paresthesia, incoordination, and loss of proprioception and vibration sensation in the ankle and toes.

Pernicious anemia

Scissors gait sometimes occurs as a late sign in untreated pernicious anemia. Besides this disorder’s classic triad of symptoms—weakness, sore tongue, and numbness and tingling in the extremities—the patient may exhibit pale lips, gums, and tongue; faintly jaundiced sclerae and pale to bright yellow skin; impaired proprioception; incoordination; and vision disturbances (diplopia, blurring).

Spinal cord trauma

Scissors gait may develop during recovery from partial spinal cord compression, particularly with an injury below C6. Associated findings may include sensory loss or paresthesia, muscle weakness or paralysis distal to the injury, and bladder and bowel dysfunction.

Spinal cord tumor

Scissors gait can develop gradually from a thoracic or lumbar tumor. Other findings reflect the location of the tumor and may include radicular, subscapular, shoulder, groin, leg, or flank pain; muscle spasms or fasciculations; muscle atrophy; sensory deficits, such as paresthesia and a girdle sensation of the abdomen and chest; hyperactive DTRs; bilateral Babinski’s reflex; spastic neurogenic bladder; and sexual dysfunction.

Stroke

Scissors gait occasionally develops during the late recovery stage of bilateral occlusion of the anterior cerebral artery. The patient may also display leg muscle paraparesis and atrophy, incoordination, numbness, urinary incontinence, confusion, and personality changes.

Syphilitic meningomyelitis

Scissors gait appears late in this disorder and may improve with treatment. The patient may also experience sensory ataxia, changes in proprioception and vibration sensation, optic atrophy, and dementia.

Syringomyelia

Scissors gait usually occurs late in this disorder along with analgesia and thermanesthesia, muscle atrophy and weakness, and Charcot’s joints. Other effects may include loss of fingernails, fingers, or toes; Dupuytren’s contracture of the palms; scoliosis; and clubfoot. Skin in the affected areas is typically dry, scaly, and grooved.

Special considerations

Because of the sensory loss associated with scissors gait, provide meticulous skin care to prevent skin breakdown and pressure ulcer formation. Also, give the patient and his family complete skin care instructions. If appropriate, provide bladder and bowel retraining.

Promote daily active and passive range-of-motion exercises. Refer the patient to a physical therapist, if appropriate, for gait retraining and for possible application of in-shoe splints or leg braces to maintain proper foot alignment for standing and walking.

Pediatric pointers

The major causes of scissors gait in children are cerebral palsy, hereditary spastic paraplegia, and spinal injury at birth. If spastic paraplegia is present at birth, scissors gait becomes apparent when the child begins to walk, which is usually later than normal.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Walking symptoms: Introduction (review 483 causes)
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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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