title: Unstable gait due to spasticity of the rectus femoris: gait analysis and motor nerve block.
abstract: We present the case of a 54 year-old man presenting with a right Brown-Séquard plus syndrome (BSPS) after a traumatic cervical spinal cord injury. After being operated on with selective tibial neurotomy and triceps surae lengthening because of a right spastic equinus foot, he developed a gait disorder at high speed. The patient complained about an instability of the right knee. Observational gait analysis exhibited an oscillating, flexion/extension motion of the right knee during stance, which was confirmed by gait analysis. Dynamic electromyographic recordings exhibited a clonus of the right rectus femoris (RF) during stance. The spastic activity of the RF and the abnormal knee motion totally reversed after a motor nerve block of the RF, as well as after botulinum toxin type A injection into the RF. We emphasize that complex, spastic gait disorders can benefit from a comprehensive assessment including gait analysis and nerve blocks.
authors.affiliation: Laboratoire d'analyse du mouvement, service de médecine physique et de réadaptation neurologique, hôpital Saint-Jacques, CHU de Nantes, 85, rue Saint-Jacques, 44093 Nantes cedex, France. raphael.gross@chu-nantes.fr
authors.forename: R
authors.initials: R
authors.lastname: Gross
authors.forename: F
authors.initials: F
authors.lastname: Leboeuf
authors.forename: O
authors.initials: O
authors.lastname: Rémy-Néris
authors.forename: B
authors.initials: B
authors.lastname: Perrouin-Verbe
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D004576:Electromyography; D005684:Gait / Q000502:physiology*; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons; D009128:Muscle Spasticity / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy*; D009407:Nerve Block; D009465:Neuromuscular Agents / Q000627:therapeutic use; D052097:Quadriceps Muscle / Q000503:physiopathology*
chemical_list: D009465:Neuromuscular Agents; D008012:Lidocaine; D019274:Botulinum Toxins, Type A