Suspected feigned knee extensor weakness: Usefulness of 3D gait analysis. Case report

The purpose of the present case report is to show the potential for use of 3D gait analysis as an assessment method of feigned muscle weakness.We describe a patient complaining of right leg pain and weakness. Physical examination showed severe quadriceps muscle weakness in a highly abnormal gait pattern context. Conventional diagnostic workup did not show any relevant findings. Three-dimensional (3D) gait analysis was performed with a 3D motion capture system. Joint angles, internal moments and powers were computed from the motion data. Lower leg muscle surface-electromyography was also performed. During the late stance phase, flexor moment and negative power peaks (indicating eccentric knee extensor activity) were generated in the knee, together with relevant Rectus femoris activity. All findings were highly inconsistent with true quadriceps weakness and gave objective ground to suspect insincerity of patient complaints. 3D gait analysis might be a valuable clinical assessment tool in suspected feigned lower limb muscle weakness.