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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 7, pp 1987–1991 | Cite as

Pathomechanics of Gowers’ Sign: A Video Analysis of a Spectrum of Gowers’ Maneuvers

  • Richard F. Chang
  • Scott J. Mubarak
Clinical Research

Abstract

Background

Gowers’ sign is a screening test for muscle weakness, typically seen in Duchenne muscular dystrophy but also seen in numerous other conditions. The mildest presentations and the variations of Gowers’ sign are poorly described in the literature but are important to recognize to help with early diagnosis of a neuromuscular problem.

Questions/purposes

We therefore (1) defined the characteristics of the mildest forms and the compensatory mechanism used, (2) categorized the spectrum of this sign as seen in various neuromuscular diseases, and (3) provide educational videos for clinicians.

Methods

We videotaped 33 patients with Gowers’ sign and three healthy children. Weakness was categorized as: mild = prolonged or rise using single-hand action; moderate = forming prone crawl position and using one or two hands on thigh; severe = more than two thigh maneuvers, rising with additional aid, or unable to rise.

Results

The earliest changes were exaggerated torso flexion, wide base, and equinus posturing, which reduce hip extension moment, keep forces anterior to the knee, and improve balance. Patients with moderate weakness have wide hip abduction, shifts in pelvic tilt, and lordosis, which reduce knee extension moment, improve hamstrings moment arm, and aide truncal extension. The classic Gowers’ sign (severe) exaggerates all mechanisms.

Conclusions

The classically described Gowers’ sign is usually a late finding. However more subtle forms of Gowers’ sign including mild hand pressure against the thigh and prone crawl position should be recognized by clinicians to initiate additional diagnostic tests.

Level of Evidence

Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Muscular Dystrophy Spinal Muscular Atrophy Pelvic Tilt Neuromuscular Disease Duchenne Muscular Dystrophy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 1 (WMV 14559 kb)

Video 2 (WMV 24796 kb)

Video 3 (WMV 43171 kb)

Video 4 (WMV 41546 kb)

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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Department of OrthopedicsUniversity of California, San DiegoSan DiegoUSA
  2. 2.Rady Children’s Hospital and Health CenterSan DiegoUSA

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