Neurological - Lower Limb Flashcards
Sites of UMN vs LMN
UMN - brain, spinal cord
LMN - nerve root, peripheral nerve, NMJ, muscle
Plantars in UMN vs LMN
Upgoing/extensor (Babinski POSITIVE) = UMN
Downgoing/flexor (normal) or mute (no movement) = LMN
Fasciculations/wasting in UMN vs LMN
None = UMN
Prominent = LMN (think fasciculations in MND)
Tone in UMN vs LMN
Increased (spasticity/rigidity) +/- ankle clonus = UMN
Decreased/normal = LMN
Muscular signs on general inspection
Wasting
Fasciculations + pseudoathetosis (writhing)
Tremor, chorea, myoclonus
Tardive dyskinesia
Non-muscular signs on general inspection
Scars
Hypomimia
Ptosis + frontal balding
Ophthalmoplegia
Ataxic gait
Broad-based, unsteady + vestibular or proprioceptive dysfunction (stare at feet to compensate)
Parkinsonian gait
Small, shuffling steps
Stooped posture
Reduced arm swing
May be rushed and get stuck
High-stepping gait
Foot drop (weakness of ankle dorsiflexion), can’t walk on heels
Waddling gait
Shoulders sway from side to side, lifting legs by tilting trunk (proximal lower limb weakness e.g. osteomalacia or myopathy)
Hemiparetic gait
One leg held stiffly + swings round in an arc (stroke)
Spastic paraparesis
Bilateral stiff + circumducting legs (hereditary)
5 elements of gait assessment
Stance
Stability
Arm swing
Steps
Turning
Romberg’s test technique
Patient feet together + arms by their sides
Close eyes
- positive if they lose balance (positive Romberg’s sign)
Pathophysiology of positive Romberg’s
Either a proprioception problem or vestibular problem (as vision is eliminated by closing eyes)
Proprioception = B12 def, Parkinson’s, ageing, joint hyper mobility (Ehlers-Danlos)
Vestibular = vestibular neuronitis, Meniere’s
Hip flexion myotome + muscle
L1/2 - iliopsoas
Hip extension myotome + nerve + muscle
L5/S1/S2 - inferior gluteal nerve - gluteus maximus
Knee flexion myotome + nerve + muscle
S1 - sciatic nerve - hamstrings
Knee extension myotome + nerve + muscle
L3/4 - femoral nerve - quadriceps
Ankle dorsiflexion myotome + nerve + muscle
L4/5 - deep peroneal nerve - tibialis anterior
Ankle plantar flexion myotome + nerve + muscle
S1/2 - tibial nerve - gastrocnemius/soleus
Big toe extension myotome + nerve + muscle
L5 - deep peroneal nerve - extensor hallucis longus
Nerve roots of each of the reflexes?
Knee-jerk = L3/4
Ankle-jerk = S1
Plantar = L5, S1
Lower limb dermatomes?
L1 - inguinal region, top of medial thigh
L2 - middle/lateral anterior thigh
L3 - groin + medial aspect of knee
L4 - medial aspect of lower leg + ankle
L5 - lateral aspect of lower leg + dorsum of foot (assess dorsum + medial aspect of big toe)
S1 - dorsum and lateral aspect of little toe (heel too)
Coordination test technique
Heel-to-shin test = ask pt to put heel on opposite knee then run it down and then up their shin, ask to repeat it continuously. Then repeat on other leg
