Lower Leg Neuro Exam Flashcards
What may cause a ataxic gait?
Cerebellar pathology or sensory ataxia
What causes a high-stepping gait?
Foot drop (weakness of ankle dorsiflexion)
What causes a waddling gait?
Proximal lower limb weakness e.g. myopathy
What causes hemiparetic gait?
Stroke
What gives spastic paraparesis?
Hereditary spastic paraplegia
What myotome causes hip flexion?
L1/L2 (iliofemoral nerve)
What muscles are assessed in hip flexion?
Iliopsoas
What myotome is assessed in hip extension?
L5/S1 (sciatic nerve)
What muscles are assessed in hip extension?
Gluteus Maximus
What myotome is assessed in knee flexion?
S1 (sciatic nerve)
What muscles are assessed in knee flexion?
Hamstrings
What myotome is assessed in knee extension?
L3/4 (femoral nerve)
What muscles are assessed in knee extension?
Quadriceps
What myotome is assessed in ankle dorsiflexion?
L4/5 (deep peroneal nerve)
What muscles are assessed in ankle dorsiflexion?
Tibialis anterior
What myotome is assessed in ankle plantarflexion?
S1/2 (tibial nerve)
What muscles are assessed in ankle plantarflexion?
Gastrocnemius and soleus
What myotome is assessed in big toe extension?
L5 (deep peroneal nerve)
What muscles are assessed in big toe extension?
Extensor hallucis longus
Which myotomes are assessed during the knee-jerk reflex?
L3 & L4
What myotomes are assessed in the ankle-jerk reflex?
S1
What myotomes are assessed in the plantar reflex?
L5 & S1
What is the Babinski sign?
- Extension of the big toe and spread of the other toes when something is traced on the sole of the foot.
- Suggests UMN lesion
Where can the L1 dermatome be tested?
Inguinal region and very top of the medial thigh
Where can the L2 dermatome be tested?
Middle and lateral aspect of the anterior thigh
Where can the L3 dermatome be tested?
Medial aspect of the knee
Where can the L4 dermatome be tested?
Medial aspect of the lower leg and ankle
Where can the L5 dermatome be tested?
Dorsal and medial aspect of the big toe
Where can the S1 dermatome be tested?
Dorsal and lateral aspect of the little toe
What is the purpose of the heel-to-shin test?
- Assesses lower limb co-ordination
- Suggestive of ipsilateral cerebellar pathology
What assessments/investigations should be done after a lower limb neuro exam?
- Full neurological examination
- Neuroimaging
