Neuro examination - Lower Limbs Flashcards
What are the steps in the lower limb examination?
Observation
Tone + Clonus
Power
Co-ordination
Reflexes
Plantar response
Sensation
Gait
Observation
SWIFT
Scars
Muscle Wasting
Involuntary movements
Fasciculations
Tremoes
Skeletal deformities
Tone
With patient lying supine, ask them to relax, performing passive movements of:
- Hip rotation
- Hip and knee flexion
- Knee lift and drop method - testing for spasticity
-
Clonus - perform a sudden movement of ankle dorsiflexion
- If this sets of brisk rhythmic calf contractions, then clonus is present
Power
Test power against resistance for:
- Hip flexion and extension
- Knee flexion and extension
- Ankle dorsiflexion and plantarflexion
- Big toe extension
- Patient pulls big toe towards them
Power is graded using the MRC scale
Co-ordination
Assessed using Heel-shin test
It is also important to assess lower limb coordination by examining gait
Reflexes
- Knee reflex (L3,4)
- Place your left forearm under one knee and gently lift the leg off the bed and strike patellar tendon
- Ankle reflex (S1)
- Ask patient to flex their right knee and externally rotate the right hip
Remember reinforcement when appropriate
- Assess Plantar response - looking for extension of big toe (abnormal)
Sensation
Light touch sensation and Pinprick sensation of following areas:
- Medial and Lateral aspect of each foot
- Medial and Lateral shin
- Median, Mid and Lateral thigh
Vibration sense (128Hz tuning fork) Over the big toe metatarsophalangeal joint
Test Joint position by making movements of the big toe with patient eyes closed
Rhombergs Test
Gait
Observe patient:
- Walking and turning
- Walking heel-to-toe
- Rising from sitting
- Walking on tiptoe and on heels
Look for:
- The leg movements
- The patient’s posture
- The presence or absence of arm swing
