Clinical skills: lower limb neuro exam Flashcards
Components of the lower limb neurological exam?
Initial approach
General inspection
Special tests
Look
Feel
Motor system: tone, clonus, power, reflexes, coodrination
Sensory system: light touch, pain, temperature, vibration, proprioception, two point discrimination
INITIAL APPROACH
Same as upper limb?
Same
GENERAL INSPECTION
Same as upper limb?
Yes
TESTS
What are the 5 tests?
Gait test
Romberg’s test
Trendelenburg’s test
Proximal muscle strength test
Pull test
TESTS
Describe each of the tests:
- Gait test
- Romberg’s test
- Proximal muscle strength test
- Pull test
Gait test: heel to toe, tip toe, heels
Romberg’s test: stand feet together, hands by side, closed eyes
Proximal muscle strength test: stnad from squat without using arms for assistance
Pull test: pull patient from behind at shoulders (don’t actually do in APEX)
LOOK
Same as upper limb?
Yes, except look at calves and quadriceps instead
FEEL
Same as upper limb?
Yes
MOTOR SYSTEM
How to perform tone?
Get patient to relax
Angle: passively circle the ankles
Knees: lie patient down, get them to relax; passively flex and extend leg
MOTOR SYSTEM
Clonus: how to perform? Positive clonus?
Hold ankle as shown, then quickly passively dorsiflex the foot (sharp jolt).
Positive: foot moves up and down afterwards
MOTOR SYSTEM
Reflexes: what are they? How to perform?
Knee (patellar tendon)
Ankle (Achilles tendon)
Plantar (Babinski sign)
MOTOR SYSTEM:
Coordination: what are they?
Heel shin test (rub heel up and down shin)
Toe finger test
Foot tapping test (dysdiadokinesis) (slap hands with feet)
SENSORY SYSTEM
Dermatomes aside, are they the same as upper limb?
Yes
SENSORY SYSTEM
Where to tap for the lower limb dermatomes
