Gowers sign

Description

Physical examination finding seen in patients with proximal weakness of the extensor muscles of the thighs and is most often associated with Duchenne muscular dystrophy. Process of arising from the squatting position with the aid of the hands placed on the floor beside and behind the feet to give a push upward. The patient is unable to stand from a sitting position with the arms outstretched. Gowers first described the sign in a lecture he gave at Queen Square on ‘Pseudo-HypertrophicMuscular Paralysis’ in July, 1879:


History

I call your attention to this action, placing the hands on the knees in rising, because it is probably pathognomonic. Attention was called to it by Duchenne, and I have never seen it absent in a case so long as the patient possessed the necessary muscular power. I have never seen it in any other disease, and every doubtful case in which it was present ultimately proved to be an example of the affection. Its diagnostic importance is thus very great

Gowers 1879: 4
Gowers sign 1879 Pseudo-HypertrophicMuscular Paralysis

In getting up they first put the hands on the ground (1), then stretch out the legs behind them far apart, and, the chief weight of the trunk resting on the hands, by keeping the toes on the ground and pushing the body backwards, they manage to get the knees extended, so that the trunk is supported by the hands and feet, all placed as widely apart as possible (2), Next the hands are moved alternately along the ground backwards, so as to bring a larger portion of the weight of the trunk over the legs. Then one hand is placed upon the knee (3), and a push with this and with the other hand on the ground is sufficient to enable the extensors of the hip to bring the trunk into the upright posture. Gowers 1879: 36


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References


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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