Neurological - Lower Limb

Question 1

Sites of UMN vs LMN

Answer 1

UMN - brain, spinal cord
LMN - nerve root, peripheral nerve, NMJ, muscle

Question 2

Plantars in UMN vs LMN

Answer 2

Upgoing/extensor (Babinski POSITIVE) = UMN
Downgoing/flexor (normal) or mute (no movement) = LMN

Question 3

Fasciculations/wasting in UMN vs LMN

Answer 3

None = UMN
Prominent = LMN (think fasciculations in MND)

Question 4

Tone in UMN vs LMN

Answer 4

Increased (spasticity/rigidity) +/- ankle clonus = UMN
Decreased/normal = LMN

Question 5

Muscular signs on general inspection

Answer 5

Wasting
Fasciculations + pseudoathetosis (writhing)
Tremor, chorea, myoclonus
Tardive dyskinesia

Question 6

Non-muscular signs on general inspection

Answer 6

Scars
Hypomimia
Ptosis + frontal balding
Ophthalmoplegia

Question 7

Ataxic gait

Answer 7

Broad-based, unsteady + vestibular or proprioceptive dysfunction (stare at feet to compensate)

Question 8

Parkinsonian gait

Answer 8

Small, shuffling steps
Stooped posture
Reduced arm swing
May be rushed and get stuck

Question 9

High-stepping gait

Answer 9

Foot drop (weakness of ankle dorsiflexion), can’t walk on heels

Question 10

Waddling gait

Answer 10

Shoulders sway from side to side, lifting legs by tilting trunk (proximal lower limb weakness e.g. osteomalacia or myopathy)

Question 11

Hemiparetic gait

Answer 11

One leg held stiffly + swings round in an arc (stroke)

Question 12

Spastic paraparesis

Answer 12

Bilateral stiff + circumducting legs (hereditary)

Question 13

5 elements of gait assessment

Answer 13

Stance
Stability
Arm swing
Steps
Turning

Question 14

Romberg’s test technique

Answer 14

Patient feet together + arms by their sides
Close eyes
- positive if they lose balance (positive Romberg’s sign)

Question 15

Pathophysiology of positive Romberg’s

Answer 15

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

Question 16

Hip flexion myotome + muscle

Answer 16

L1/2 - iliopsoas

Question 17

Hip extension myotome + nerve + muscle

Answer 17

L5/S1/S2 - inferior gluteal nerve - gluteus maximus

Question 18

Knee flexion myotome + nerve + muscle

Answer 18

S1 - sciatic nerve - hamstrings

Question 19

Knee extension myotome + nerve + muscle

Answer 19

L3/4 - femoral nerve - quadriceps

Question 20

Ankle dorsiflexion myotome + nerve + muscle

Answer 20

L4/5 - deep peroneal nerve - tibialis anterior

Question 21

Ankle plantar flexion myotome + nerve + muscle

Answer 21

S1/2 - tibial nerve - gastrocnemius/soleus

Question 22

Big toe extension myotome + nerve + muscle

Answer 22

L5 - deep peroneal nerve - extensor hallucis longus

Question 23

Nerve roots of each of the reflexes?

Answer 23

Knee-jerk = L3/4
Ankle-jerk = S1
Plantar = L5, S1

Question 24

Lower limb dermatomes?

Answer 24

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)

Question 25

Coordination test technique

Answer 25

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