Peripheral Nerve - Lower Limb

Question 1

Outline the steps briefly to a lower limb neuro examination

Answer 1

WIPE –> gait –> Rombergs –> tone –> power –> coordination –> sensation –> end pieces

Question 2

What’s involved in the tone part of a lower limb neuro examination?

Answer 2

HIP: roll each leg side to side

KNEE: passively extend and flex

ANKLE: passively extend and flex

Question 3

Describe how increase in tone might feel in lower limb exam and the causes of this

Answer 3

UMN disorders - initial resistance followed by sudden reduction in resistance

Basal ganglia disorders - sustained resistance throughout movement

Parkinson’s - increased resistance

Question 4

What causes decreased muscle tone in the lower limb neuro exam?

Answer 4

Lower motor neurone lesion or cerebellar lesion

Question 5

How do you test power of the lower limb?

Answer 5

The following movements are performed first by the patient and then against resistance:

HIP: in, out, up, down

KNEE: flex, extend

ANKLE: dorsiflex, plantarflex

BIG TOE: flex, extend

Question 6

How do you test lower limb coordination?

Answer 6

Heel-shin test

Toe-tapping

Clonus

Question 7

What reflexes do you test in lower limb? What nerve roots are being tested with each of these?

Answer 7

• patellar (L3/L4)
• ankle jerk (S1/S2)
• plantar (S1)

Question 8

What nerve root does the patellar reflex test?

Answer 8

L3/L4

Question 9

What nerve root does the plantar reflex test?

Answer 9

S1

Question 10

What lesion causes clonus in the ankle?

Answer 10

UMN lesion (causes gastrocnemius to contract causing foot to move back and forwards)

Question 11

How do you test sensation in a lower limb examination?

Answer 11

Light touch then sharp touch in each dermatome

Question 12

How do you test proprioception in lower limb examination?

Answer 12

Ask patient to close eyes

Move the DIP of big toe up and down explaining which movement is which

Then 3 times, move it either up or down and ask patient what you’re doing

Question 13

How do you test vibration sense in the lower limb examination?

Answer 13

Get a tuning fork

Place on sternum as a reference point for patient

Then place vibration on DIP of big toe, asking patient when they can detect it and when they can stop feeling it

If patient can’t feel it keep moving upwards to more proximal joints until they can detect it

Question 14

What is Rombergs test?

Answer 14

LL neuro exam

Ask patient to close eyes are bring feet together