Lower Limb Neurological Examination Questions [Complete] Flashcards
Please assess the patients gait.
“Im going to assess your walking. Are you able to walk unassisted?”
“Could I ask you to sit up and swing your legs over to the side of the bed for me?” “Id like you to now cross your arms and stand up for me”.
“Id like you to now walk to the end of the room and then turn around to and walk back to me”
Look for:
Stance (e.g. wide-based could indicate cerebellar dysfunction)
Stability (e.g. instability indicates cerebellar dysfunction)
Arm swinging (Lack of swinging can indicate parkinsons)
Steps (small shuffling = parkinsons)
Turning (difficulty turning could indicate cerebellar disease or parkinsons).
Please assess the patient’s tandem gait.
“Id like you to walk to the end of the room, placing one foot in front of the other like this”.
“Now ill like you to turn around and do the same thing walking back to me”
Please assess the patient’s proprioception
Please perform the Romberg’s test on this patient
“Can i ask you to put your feet together and hands to your sides like this.” “Now close your eyes, I will be here to support you if you feel like youre toppling over”.
Please perform the Trendelenburg test to assess the hip adductors.
“Id like you to stand up for me, im now just going to touch your hip”
(Stand behind patient and feel for the hips on both sides, they should be symmetrical).
“Now id like you to stand on one leg”
(Look to see if the unsupported side’s pelvis tilts downwards as this is a positive sign that the hip adductor on the oppsoite side is paralysed)
“Now id like you to stand on the opposite leg this time”
Breifly assess the muscle tone of the hips
“Im just going to assess for the tone in your legs, can you let your legs go floppy for me”
Perform a leg roll by grabbing the knee and shaking.
Breifly assess the muscle tone of the knee and ankle.
“I am now going to briskly lift your knees and drop them. During this id like you to relax and go floppy for me”.
Lift each knee briskly off the bed (warning the patient first) and observe the movement of the leg. In patients with normal tone, the knee should rise whilst the heel remains in contact with the bed (the heel will typically lift off the bed if there is increased tone).
Briefly assess the muscle tone of the lower limbs.
Perform a leg roll and leg drop
Please assess the patient for ankle clonus.
“Id like you to go floppy for me and I will support your knee and ankle”
Rapidly dorsiflex and evert (outwards) the foot and then keep in position and observe for clonus.
Please assess the power of hip flexion. Please state the myotome being asssessed for.
“Id like you to lift up your leg for me”
“Stop me from trying to push your leg down”
Repeat on the opposite side (also make sure you are pressing against the pelvis on the oppsoite side of leg tested).
L1/2
Please assess the power of hip extension. Please state the myotomes being asssessed for.
“Id like you to push your leg against the bed for me and stop me from lifting it up”.
(Stabilise the pelvis on the same side)
L5/S1
Please assess the power of hip adduction. Please state the myotome being assessed for.
“Push your legs together for me”
L2/3
Please assess the power of hip abduction Please state the myotome being asssessed for.
“Try yo push your legs away from eachother”
L4/L5
Please assess the power of knee flexion. Please state the myotome asssessed for.
“Bend your knee so that your foot is flat on the bed and then don’t let me pull your leg towards me.”
S1
Please assess the power of knee extension. Please state the myotome asssessed for.
“Id like you to place your foot flat on the bed for me”
“Id like you to now try to straighten your leg for me”
L3/L4
Please assess the power ankle dorsiflexion. Please state the myotome being asssessed for.
“Id like you to try and bring your toes towards you and stop me from pushing them down”
L4
(Remember to support above the ankle joint)
Please assess the power of ankle plantarflexion. Please state the myotome being asssessed for.
“Id like you to try and push your foot against my hand”
S1/2
Please assess the power of the extensor hallucis longus (big toe extension). Please state the myotome being asssessed for.
“Id like you to try and bring your big toe towards you and stop me form pushing it down”
L5
Please assess the power of ankle inversion. Please state the myotome being asssessed for.
“Can you push your foot in against my hand?”
L4
Please assess the power of ankle eversion. Please state the myotome being asssessed for.
“Can you push your foot out and against my hand?”
L5/S1
Please assess the knee-jerk reflex. State what myotome is being tested for.
“Im now going to test your reflexes which will involve be tapping on your knee with a tendon hammer. Id like your legs to go floppy for me”.
L3/L4
Assess the ankle-jerk reflex in each of the patient’s lower limbs. State the myotome is being tested for.
“Im now going to test your reflexes which will involve be tapping on your achilles with a tendon hammer”
“Could you bend this leg and let it flop out to the side for me”
“And now just relax your ankle”
L5/S1
Assess the plantar reflex for babinki’s sign in each of the patient’s lower limbs. State the myotome is being tested for.
“Im now going to assess for the foot reflex which will involve me placing the blunt end of this neurotip along the sole of your foot. It nay feel a little ticklish”
S1
Assess light touch sensation across lower limb dermatomes. Name each dermatome that is being assessed for.
“Im now going to assess for sensation of the skin. I will be using a cotton wool and will be placing it like this. Could you feel that? Okay so I want you to close your eyes and each time you feel the cotton wool on your skin id like you to say ‘yes’”.
L2: : middle and lateral aspect of the anterior thigh
L3: to the knee (medial aspect of the knee)
L4: medial aspect of the lower leg and ankle
L5: dorsum and medial aspect of the big toe
S1: dorsum and lateral aspect of the little toe
“Did that feel the same on both sides?”
Please assess the patient’s proprioception by testing for joint position sense.
“Im just going to take your big toe and show you that this is up and this is down. Im going to ask you to close your eyes for me and tell me if you feel like your toe is pointing up or down.
(Do this 3 times per thumb)
“Open your eyes for me. This is up and this is down [Opposite toe this time]
N.B. DO NOT TOUCH THE NAILBED AS PRESSURE CAN GIVE A CLUE
Please perform the heel to shin test
“I want you to put this ankle on the other knee”
“Run it down your leg then lift it up”
“Bring it back to your knee again and keep repeating”
Please peform the rapid alternating movement test to assess for dysdiachokinesia. [UPPER LIMB]
“Id like you to place your hands out like this [gesture with palms facing out]. I want you to place your hands together like this [palms touching] and then place your hands like this [right hands back part on the other palm] and alternate between these movements like so”
