Lower Limb Neuro Exam

Question 1

Can’t walk heel to toe

Answer 1

Midline cerebellar disease

Question 2

Can’t walk on toes

Answer 2

Don’t have intact S1 nerve root

Question 3

Can’t walk on heels

Answer 3

Don’t have intact L4 and L5

Question 4

What does an abnormal Romberg test show?

Answer 4

If marked unsteadiness with eyes closed such that they open their eyes they have a lesion of the proprioceptive pathways

If marked unsteadiness with eyes open = cerebellar or vestibular disease/dysfunction

Question 5

What causes hypertonia?

Answer 5

Progressive loss of inhibitory input in descending pathways (reticulospinal and vestibulospinal)

Question 6

Is there is hypertonia what do you do?

Answer 6

Clonus test:

Hip externally rotated, knee partially flexed and sharply dorsiflex ankle and hold position for a few seconds

If you have recurrent plantar flexion movement you have clonus (due to increase in excitability of ankle stretch reflex with an upper motor neuron lesion so that there is a loss of descending inhibition of the reflex arc)

Question 7

Hip flexion myotome

Answer 7

L2 L3

Question 8

Hip extension myotome

Answer 8

L4 L5

Question 9

Hip abduction myotome

Answer 9

L4 L5 S1

Question 10

Hip adduction myotome

Answer 10

L2 L3 L4

Question 11

Knee flexion myotome

Answer 11

L5 S1

Question 12

Knee extension myotome

Answer 12

L3 L4

Question 13

Ankle dorsiflexion myotome

Answer 13

L4 L5

Question 14

Ankle plantarflexion dermatome

Answer 14

S1 S2

Question 15

Foot inversion mytome

Answer 15

L4 L5

Question 16

Foot eversion myotome

Answer 16

L5 S1

Question 17

Hallux extension myotome

Answer 17

L5 S1