Lower Limb Neuro Exam 2 Flashcards
What myotome is assessed in hip flexion?
L1/2 iliofemoral nerve
What muscle is assessed in hip flexion?
iliopsoas
What myotome is assessed in hip extension?
L5/S1/S2 (inferior gluteal nerve)
What muscle is assessed in hip extension?
gluteus maximus
What myotome is assessed for knee flexion?
S1 (sciatic nerve)
What muscle is 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 muscle is assessed in ankle dorsiflexion?
tibialis anterior
What myotome is assessed in ankle plantarflexion?
S1/2 (tibial nerve)
What muscle is assessed in ankle plantarflexion?
gastrocnemius, soleus
What myotome is assessed in big toe extension?
L5 (deep peroneal nerve)
What muscle is assessed in big toe extension?
extensor hallucis longus
What is the pattern of muscle weakness in upper motor neurone lesions?
- cause a ‘pyramidal’ pattern of weakness that disproportionately affects lower limb flexors and upper limb extensors
- lower limb flexors are weaker than extensors in a lower limb neurological assessment
What is the pattern of muscle weakness in lower motor neuron lesions?
focal pattern of weakness, with only the muscles directly innervated by the damaged neurones affected
What does MRC 0 mean?
no contraction
What is MRC 1?
flicker or trace of contraction
What is MRC 2?
active movement with gravity eliminated
What is MRC 3?
active movement against gravity
What is MRC 4?
active movement against gravity and resistance
What is MRC 5?
normal power
What does the knee-jerk reflex test?
L3, L4
What does the ankle-jerk reflex test?
S1
What does the plantar reflex test?
L5, S1
What is hyperreflexia associated with?
upper motor neuron lesions due to the loss of inhibition from higher brain centres which normally exert a degree of suppression over the lower motor neuron reflex arc.
What are examples of upper motor lesions?
stroke, spinal cord injury
What is hyporeflexia assoicted with?
lower motor neuron lesions due to loss of the efferent and afferent branches of normal reflex arc
What are examples of LMN lesions?
e.g. brachial plexus pathology or other peripheral nerve injuries
What are reflexes like in cerebellar disease?
- pendular
- means less brisk and slower in their rise and fall
- sign is subjective and often reflexes appear to be ‘normal’ in cerebellar disease
What does light tough sensation involve?
dorsal column and spinothalamic tracts
What does pin prick sensation involve?
spinothalamic tract
What does vibration sensation involve?
dorsal columns
What tuning fork is used?
128hz
What joint is vibration placed?
place onto the interphalangeal joint of the patient’s big toe
If they can’t identify when vibration starts and stops which joints do you check?
metatarsophalangeal joint of the big toe → ankle joint → knee joint until the patient is able to accurately identify vibration
What does proprioception involve?
dorsal columns
What can dysmetria (incoordination) suggest?
ipsilateral cerebellar pathology
What are UMN signs in inspection?
no fasciculation or significant wasting (there may however be some disuse atrophy or contractures)
What are the LMN signs for inspection?
wasting and fasciculation of muscles
What are the UMN signs for tone?
increased (spasticity or rigidity) +/- ankle clonus
What are the LMN signs for tone?
decreased (hypotonia) or normal
What are the UMN signs on power?
classically a “pyramidal” pattern of weakness (extensors weaker than flexors in arms, and vice versa in legs)
What are the LMN signs on power?
different patterns of weakness, depending on the cause (e.g. classically a proximal weakness in muscle disease, a distal weakness in peripheral neuropathy)
What are UMN signs for reflexes?
exaggerated or brisk (hyperreflexia)
What are LMN signs for reflexes?
reduced or absent (hyporeflexia or areflexia)
What are UMN signs on plantar reflexes?
Upgoing/extensor (Babinski positive)
What are LMN signs for plantar reflexes?
normal (downgoing/flexor) or mute (i.e. no movement)
