(CPA) lower limbs exam Flashcards
what position and exposure is required for the lower limbs exam?
sitting at a 45-degree angle with as much of the leg exposed (i.e. thigh downwards)
how is the tone of the lower limb assessed?
leg roll
leg lift
ankle clonus
how is the leg roll assessment carried out?
ask patient to relax legs and go floppy
roll each leg turn by turn
how is the leg lift assessment carried out?
ask patient to relax legs and go floppy
quickly lift the leg off the bed at the knee joint
(heel should remain in contact with the bed)
how is ankle clonus assessment carried out?
lift the patient’s foot after asking them to flex their knee
quickly dorsiflex and partially evert the foot
which joints of the lower limb are assessed for power in the lower limbs exam?
hip joint
knee joint
ankle joint
how is power assessed at the hip joint in a lower limbs exam?
1) assess flexion
2) assess extension
3) assess abduction
4) assess abduction
(ask the patient to perform the action while you provide resistance)
how is power assessed at the knee joint in a lower limbs exam?
1) assess flexion
2) assess extension
(ask the patient to perform the action while you provide resistance)
how is power assessed at the ankle joint in a lower limbs exam?
1) assess dorsiflexion
2) assess plantarflexion
3) assess inversion
4) assess eversion
(ask the patient to perform the action while you provide resistance)
what is the Trendelenburg test?
evaluate the motor loss of the hip abductors (gluteus medius and minimus) of the hip joint
describe how a Trendelenburg test is carried out
ask patient to stand on both legs = both right and left pelvis should remain at same level without any tilt
ask the subject to raise one leg off the ground
pelvis should remain horizontal on one leg
(if pelvis on the unsupported, leg-lifted side drops downward = positive Trendelenberg test = loss or weakness of the motor function of the hip abductors of opposite leg)
what does a positive Trendelenburg test mean?
loss or weakness of the motor function of the hip abductors of opposite leg
which muscle group and nerve is responsible for knee extension?
quadriceps
femoral nerve
which muscle group and nerve is responsible for knee flexion?
hamstrings
sciatic nerve
which nerve enables dorsiflexion?
deep fibular nerve
which nerve enables plantarflexion?
tibial nerve
at which joint does ankle eversion and inversion take place?
subtalar joint
which reflexes are elicited as part of the lower limbs exam?
patellar tendon reflex
ankle-jerk reflex
describe how the patellar tendon reflex is elicited
ensure that the patient’s legs are hanging freely over the side of the bed and is
completely relaxed
tap the patellar tendon w the hammer
describe how the calcaneal tendon reflex (ankle jerk) is elicited
support the leg such that their hip is slightly abducted, the knee Is flexed, and
the ankle is dorsiflexed
tap the Achilles tendon w the tendon hammer
which spinal levels are linked to the patellar tendon reflex?
L3-L4
which spinal levels are linked to the calcaneal tendon reflex?
S1-S2
how can difficult reflexes be reinforced and elicited?
instruct patient to do the Jendrassik manoeuver (clenching the teeth and
flexing both sets of fingers in a hook-like form)
which dermatomes are assessed for sensation in the lower limb exam?
L1 L2 L3 L4 L5 S1 S2
explain how sensation is assessed in a lower limb exam
sensation for light touch is done w a cotton ball
assess sensation on the patient’s sternum
assess sensation across each of the lower limb dermatomes, comparing left to right at equivalent regions
where is the L1 dermatome assessed for sensation?
near the mid-inguinal point
where is the L2 dermatome assessed for sensation?
lateral side of thigh
where is the L3 dermatome assessed for sensation?
lower medial side of thigh (just above knee joint)
where is the L4 dermatome assessed for sensation?
great toe
where is the L5 dermatome assessed for sensation?
middle three toes
where is the S1 dermatome assessed for sensation?
little toe
where is the S2 dermatome assessed for sensation?
back of upper thigh
