Lower Limb Examination Flashcards
In what order is lower limb examination carried out?
- Observation
- Tone/Clonus
- Power
- Co-ordination
- Reflexes
- Sensation
- Gait
What are we looking for in observations?
S - skeletal deformity, scars
W - muscle easting/atrophy
I - involuntary movements
F- muscle fasciculation
T- Tremor
How is Tone assesed?
Check for pain
Patient lying supine, ask them to relax. Test tone by doing passive moveemnts of:
* Hip and knee flexion (drop method) compare sides
How is clonus assesed?
Perform sudden movement of ankle dorsiflexion
Positive: set of brisk rhytmic calf contractions (beating of foot)
Few beats of clonus can be normal, sustained clonus abnormal
What is ankle clonus?
Brisk rhytmic contraction of calf muscles
How is power assesed?
Remember we test power against resistance.
• hip flexion and extension: straight leg raise. Push up/down against resistance
• knee flexion and extension: pull knee towards bottom/ push against
• ankle dorsiflexion and plantarflexion: push dosral aspect fo foot against hand/ push plantar aspect fo foot agsint hand
• big toe extension (EHL – extensor hallucis
longus: pull big toe towards them
Grade 5-0
How is co-ordination tested?
Heel-shin test: ask pt to take teh heel of one leg put it on knee of other and run down shin over and over again
How are reflexes tested?
- Knee reflex
- Ankle reflex
- Plantar response: stroke lateral aspect of foor with blunt neurotip (toe moves down: normal flexor response, toe moves up: abnormal extensor reposne)
How is sensation assesed?
Assess Sensation:
• Light touch: cotton wool,close eyes, cover L2-S1 dermatomes
• Pinprick (pain): neurotip eyes closed, cover L2-S1 dermatomes
• Vibration: Big toe metatarsopharyngeal joint (128 Hz tuning fork)
• Joint position sense: close eyes, small up and down movements of big toe. Compare sides
Romberg’s test: stand with feet close together. Put one arm infront and one behind, not touching. Ask to close eyes, if they become unsteady on closing eyes, suggest proprioception issue
How is gait assesed?
Ask pt to walk short distance, turnaround on the spot and walk back.
Look for:
* Leg movements
* Posture
* Prsence/absence of arm swing
How is balance tested?
Heel to toe walk (tandem-walking)
How is proximal lower limb power tested?
Ask pt to rise from chair without using arms/rise from squat
How is distal limb power tested?
Ask pt to ealk on heels and stand on tip toes
How are deep tendon reflexes recorded?
Increased/exaggerated/brisk: +++
Normal: ++
Reduced: +
Only present with reinforcement: +/-
Absent: -
What does an abnormally brisk deep tendon reflex indicate?
UMNL
How is the Babinski sign interpreted?
