Lower Leg Neuro Exam

Question 1

What may cause a ataxic gait?

Answer 1

Cerebellar pathology or sensory ataxia

Question 2

What causes a high-stepping gait?

Answer 2

Foot drop (weakness of ankle dorsiflexion)

Question 3

What causes a waddling gait?

Answer 3

Proximal lower limb weakness e.g. myopathy

Question 4

What causes hemiparetic gait?

Answer 4

Stroke

Question 5

What gives spastic paraparesis?

Answer 5

Hereditary spastic paraplegia

Question 6

What myotome causes hip flexion?

Answer 6

L1/L2 (iliofemoral nerve)

Question 7

What muscles are assessed in hip flexion?

Answer 7

Iliopsoas

Question 8

What myotome is assessed in hip extension?

Answer 8

L5/S1 (sciatic nerve)

Question 9

What muscles are assessed in hip extension?

Answer 9

Gluteus Maximus

Question 10

What myotome is assessed in knee flexion?

Answer 10

S1 (sciatic nerve)

Question 11

What muscles are assessed in knee flexion?

Answer 11

Hamstrings

Question 12

What myotome is assessed in knee extension?

Answer 12

L3/4 (femoral nerve)

Question 13

What muscles are assessed in knee extension?

Answer 13

Quadriceps

Question 14

What myotome is assessed in ankle dorsiflexion?

Answer 14

L4/5 (deep peroneal nerve)

Question 15

What muscles are assessed in ankle dorsiflexion?

Answer 15

Tibialis anterior

Question 16

What myotome is assessed in ankle plantarflexion?

Answer 16

S1/2 (tibial nerve)

Question 17

What muscles are assessed in ankle plantarflexion?

Answer 17

Gastrocnemius and soleus

Question 18

What myotome is assessed in big toe extension?

Answer 18

L5 (deep peroneal nerve)

Question 19

What muscles are assessed in big toe extension?

Answer 19

Extensor hallucis longus

Question 20

Which myotomes are assessed during the knee-jerk reflex?

Answer 20

L3 & L4

Question 21

What myotomes are assessed in the ankle-jerk reflex?

Answer 21

S1

Question 22

What myotomes are assessed in the plantar reflex?

Answer 22

L5 & S1

Question 23

What is the Babinski sign?

Answer 23

• Extension of the big toe and spread of the other toes when something is traced on the sole of the foot.
• Suggests UMN lesion

Question 24

Where can the L1 dermatome be tested?

Answer 24

Inguinal region and very top of the medial thigh

Question 25

Where can the L2 dermatome be tested?

Answer 25

Middle and lateral aspect of the anterior thigh

Question 26

Where can the L3 dermatome be tested?

Answer 26

Medial aspect of the knee

Question 27

Where can the L4 dermatome be tested?

Answer 27

Medial aspect of the lower leg and ankle

Question 28

Where can the L5 dermatome be tested?

Answer 28

Dorsal and medial aspect of the big toe

Question 29

Where can the S1 dermatome be tested?

Answer 29

Dorsal and lateral aspect of the little toe

Question 30

What is the purpose of the heel-to-shin test?

Answer 30

- Assesses lower limb co-ordination | - Suggestive of ipsilateral cerebellar pathology

Question 31

What assessments/investigations should be done after a lower limb neuro exam?

Answer 31

- Full neurological examination | - Neuroimaging