Lower Limb Neurological Exam Flashcards
What do you look for on general inspection
SWIfT
Scars
Wasting of muscles
Involuntary movements
fasciculations
Tremor
Look for items around the bed: walking stick/wheelchair
What does standing with arms crossed test for
Any proximal muscle weakness
What do you assess during gait
Speed
Symmetry
Balance
Arm swing
What does walking on tip-toes test
Power of plantar flexion
What does walking on heels test
Power of dorsiflexion
What is Romberg’s test and what is a positive result
Assessment of proprioception by standing with feet together and eyes closed
A positive test is a loss of balance and suggests the ataxia is sensory in nature
What do you assess in tone
During leg roll:
Spasticity of the ankle= UMN lesion
Completely floppy ankle = LMN lesion
During leg drop:
Kicking out of the ankle = UMN lesion
What is Ankle clonus and what does it indicate
It is repetitive muscle contractions and it signifies UMN lesion
What are the spinal roots of hip flexion
L1/2
What are the spinal roots of hip extension
L5/S1
What are the spinal roots of leg adduction
L2/3
What are the spinal roots of leg abduction
L4/5
What are the spinal roots of knee flexion
L5/S1
What are the spinal roots of knee extension
L3/4
What are the spinal roots of dorsiflexion
L4
What are the spinal roots of plantarflexion
S1/2
What are the spinal roots of big toe extension (1st metatarsal extension)
L5
What muscle is responsible for 1st metatarsal extension
Extensor hallucis longus
What are the spinal roots of the knee reflex
L3/4
What are the spinal roots of the ankle reflex
S1/2
What are the spinal roots of the babinski reflex and what is a positive result
S1
A positive result is when the patients big toe dorsiflexes in response, indicating UMN lesion
Describe all the dermatomes in the leg
What can you do if there is peripheral sensory loss during sensation testing
Start from a distal point and repeatedly poke as you come more proximal to identify ‘stocking’ sensory loss
What tuning fork is used during vibration testing
128Hz tuning fork
Where do you place the tuning fork and what can you do if the patient doesn’t sense any vibration
Place the tuning fork at the distal interphalangeal joint of the big toe and if the patient doesn’t sense vibration then assess vibration at a more proximal bony point
What can an abnormal knee to shin test or foot flapping indicate
Lower limb weakness
Impaired joint proprioception (knee-to-shin)
Cerebellar disorder
What examinations would you do to complete findings
Cranial nerve exam
Upper limb exam
