Neuro - lower limb

Question 1

Order

Answer 1

Inspection
Tone
Power
Reflexes
Plantars
Co-ordination - heel-shin
Sensation

Question 2

Inspection

Answer 2

Muscle wasting
Fasciculations
Tremor
Scars

Question 3

Tone

Answer 3

Ask to relax legs, let me take the weight
Compare sides!

• lift leg at knee and drop
• leg roll, holding at knee
• ankle rotation and clonus

Increased -> UMN lesion
Decreased -> LMN lesion

Question 4

Power

Answer 4

Isolate one joint at a time
Compare sides!

• legs outwards and in (thigh)
• legs up and down (thigh)
• knees up, kick out, pull in
• legs flat, ankles push up and down
• big toe, push up and down

Grading:
5 = normal
4 = reduced against resistance
3 = overcomes gravity
2 = cannot overcome gravity
1 = muscle flicker
0 = no muscle contraction

Question 5

Reflexes

Answer 5

Supported, relaxed limbs
Compare both sides!

• infrapatellar tendon - thread arm under to support
• ankle jerk - foot held lightly in dorsiflexion, tap achilles tendon
• plantar - scrape lateral part foot upwards (flexion in health, Babinski sign in UMN lesion)

Can reinforce by flexing interlocked fingers as tap - Jendrassik manouvre

Question 6

Co-ordination

Answer 6

Compare both sides!
Eyes shut, say when feel
Dermatomal distribution

• fine touch - cotton wool
• sharp touch - neuro tip
• vibration - tuning fork to distal joint, then up if don’t feel
• proprioception