Which sign is most characteristic of Duchenne muscular dystrophy?

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Duchenne muscular dystrophy causes early weakness of proximal muscles, especially the hip and thigh girdle, so children have to use their arms to help straighten up from the floor. The Gowers’ maneuver—pushing up with the hands on the thighs to stand from a seated or supine position—directly demonstrates this proximal weakness and the compensatory strategy, making it the most characteristic sign. While difficulty getting up from supine, calf pseudohypertrophy, and trouble going up and down stairs all reflect proximal weakness, they don’t convey the specific pattern as clearly or specifically as the Gowers’ sign. Pseudohypertrophy of the calves is common but can occur in other conditions and at various stages, so it’s less definitive. Similarly, stair climbing difficulty is a general sign of proximal weakness and isn’t as diagnostic as the distinctive Gowers’ sign.