Gowers’ sign indicates that there is weakness in the proximal muscles. It is usually seen in Duchenne Muscular Dystrophy (DMD). The sign describes a patient that has to use his hands and arms to walk up his body in order to achieve an erect position. This is due to weakness of the quadriceps and gluteus muscles.
The patient begins in the squatting position. This is followed by slowing lifting the hip and assuming a tripod position. The patient then places his hands on the knees as he slowly walks up his body.
When testing a patient for Gowers’ sign, make sure to perform the test away from any object or structure that the patient may use to aid his movement.
Duchenne Muscular Dystrophy (DMD)
Patients with DMD show progressive muscular weakness due to the absence of dystrophin. DMD is a genetically transmitted condition that has an x-linked recessive mode of inheritance. Healthy carrier mothers transmit the condition to their male children. The condition is characterized by progressive loss of motor strength, especially to the proximal muscle groups. Remember that this is a muscular problem, not a nerve disorder. Labs may show markedly elevated levels of creatine phosphokinase (CPK), which can reach above 25,000 IU/L.
The symptoms of DMD usually appear before 6 years of age. Children will have difficulties standing unaided and ascending stairs.
Examination
During the exam a calf pseudohypertrophy may be noted. Also, an equinovarus foot that occurs due to contracture of the gastrocnemius and soleus muscles with persistent function of the tibialis posterior muscle. They may also develop scoliosis. It is treated with fusion, if more than 20 degrees. The patient could also have cardiomyopathy. As the condition progressed, the muscle is replaced with fat and fibrotic tissue.
