Lower limb neuro

Question 1

Introduction [4]

Answer 1

Introduce myself

• Name
• Consent

Hand wash

Ask patient for limb or joint pain

Question 2

Order of examination [7]

I I T P R C S

Answer 2

Introduction

Inspection

Tone

Power

Reflexes

Co-ordination

Sensation

Question 3

Inspection [6]

Answer 3

Wasting?

Symmetry of limbs

Deformities

Scars

Abnormal movements (chorea, jerks, temor, fasciculation)

Walking sticks or use of aids

Question 4

Tone [3]

Answer 4

At the hip
- Roll lower leg side to side

At the ankle
- Check mobility

Knee
- Jerk upwards, heel will not raise if normal

Observations

• Hypertonia
• Normal
• Hypertonia

Question 5

Power [7]

Answer 5

Hip flexion + extension
- Patient leg push on and against hand

Knee flexion and extension

• Flexion: hold lower leg and ask patient to pull against
• Extension: Support knee and ask patient to push against hold on lower leg.

Ankle dorsiflexion
- Support ankle, ask patient to push against hand from dorsal foot.

Big toe extension/ dorsiflexion
- Support foot, ask patient toe to push against on anterior, then dorsal.

Observation

• Absent
• Reduced
• Normal

Question 6

Reflexes [4]

Answer 6

Knee
- L3/4

Ankle: hammer on calcaneal tendon
- L5/S1

Plantar
- Run hammer along outside foot. Abnormal= big toe extension

Babinski
- S1- UMN

Question 7

Co-ordination

Answer 7

Heel-shin test

Question 8

Sensation [3]

Answer 8

Fine touch: cotton wool
- L5 and S1 dermatomes

Vibration
- Start with big toe joint then ankle, skin, patella, asis, costal margin, xiphisternal

Propioception
- Start with big toe-ankle-knee-hip

Question 9

Dermatomes

Answer 9

L1- groin

L2- lateral upper thigh

L3- Medial lower thigh

L4- medial lower leg

L5- Dorsum foot and big toe

S1- Lateral foot and sole, little toe

S2- Back of leg

S3-5- Around anus and bum