CRUTCH WALKING ortho theory notes - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE -

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Tuesday 17 April 2018

CRUTCH WALKING ortho theory notes

  • function to prevent weight bearing – eventally to walk unaided
  • muscles required for using crutches are
    • flexors of fingers and thumb to hold the hand grip firmly
    • dorsiflexion of wrist and stabilize the wrist in dorsiflexion
    • extensors of elbow to stabilize elbow in slight flexion – to take the body wt through upper limb
    • flexion of shoulder to move the walking aid forward
    • depression of shoulder girdle to support the body wt
Image result for crutch walking
Image result for crutch walking
  • ability to use crutches efficiently depends on
    • strength of the muscles required
    • selection and adjustment of crutches
    • sense of balance
    • familiarity and manintance of crutches
    • crutch stance
    • knowledge of how to stand and balance on crutches before step
    • gait pattern
    • energy necessary for the gait pattern
  • Crutch stance for the axillary crutch
    • patient against wall – crutches placed under each arm
    • correct stance – head up – back straight – pelvis over feet – shoulder depressed – axillary pads of crutches gripped between the lateral wall of chest and medial aspect of arm , 2 inches below the anterior axillary fold – crutch tips 6 inches forward and 6 inches out from tip of toes – palms of hands on hand grips of crutches – elbows in 300 flexion – body wt taken mainly on hands
  • Gait patterns
    • swinging crutch gait
      • swing to crutch gait
      • swing through crutch gait
    • four point crutch gait
    • two point crutch gait
    • three point crutch gait
    • selection of gait depends on
      • ability of the patient to step forward with either one or two feet
      • ability to bear weight and keep balance on one or both feet
      • ability to push body forward by presssing down both crutches
      • ability to maintain body errect
      • ability to control the crutches
    • all assisted gaits need more energy
      • 2 and 3 point partial weight bearing gaits need 33% more energy than normal gait
      • 3 point non weight bearing and swing through gait need 78% more energy
  • Swinging Crutch gait
    • body wt can be taken through both lower limbs together
    • but uncapable of moving his lower limbs due to paralysis
    • calipers are used to stabilize the limbs – limbs are moved by the muscles acting on pelvis
    • stable position is of tripod – triangular base – apex on shoulder
      • crutches form two anterior legs
      • trunk and lower limbs form the posterior leg
    • paralytic is stable in this position – except no FFD of hip, knee, ankle
    • knees braced in extension – centre of gravity falls in front of the hip joint
    • swinging to crutch – advances the crutch – swings the body to crutches
    • swinging through crutch – body swings through beyond the crutches
  • Four point crutch gait
    • when all/ part of body wt can be taken on each foot – but patient is unsteady and needs wide based gait
    • as condition improves – moves to two point gait
    • right crutch – left foot (body wt on right hand) – left crutch – right foot ( body wt on left hand)
  • Two point crutch gait
    • to reduce the amount of body wt taken on both foot – some body wt can be taken by both l/l – good balance – both lowerlimbs painful/ weak
    • right crutch and left foot simoultanously ( taking part of body wt on left foot) - left crutch and right foot simultanously (taking part of body wt on right foot)
  • Three point crutch gait
    • when one limb can support the whole body wt and other cant
    • both crutches support the weak limb – stronger limb takes the whole body wt without support of crutches
    • both crutches and weak limb together – stronger lower limb
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