Lower Limb Exam

Question 1

Introduction

Answer 1

1. Wash hands
2. Introduce
3. Patient details
4. Permission: Today I have been asked to perform an examination of the nerves in your leg - this will involve me having a look, a feel and a move of your leg. We have our examiner here as chaperone. Does that sound okay?
5. Exposure - thigh to toe
6. Reposition - 45 degree
7. Any questions? Any pain?

Question 2

General inspection

Answer 2

Scars
Wasting
Involuntary movements
Fasciculations
Tremor

Offer to assess gait e.g. heel-toe walk
Romberg’s test (patient stand up, feet together, eyes closed, must be near in case they fall)

Question 3

Tone

Answer 3

Hip
Knee
Ankle (+ clonus)

Question 4

Power

Answer 4

Hip
Knee
Ankle dorsiflexion and plantarflexion
Big toe flexion + extension)

Question 5

Reflexes

Answer 5

Knee
Ankle
Planter (Babinski, should go down)

Question 6

Sensation

Answer 6

L1: the inguinal region and the very top of the medial thigh.
L2: the middle and lateral aspect of the anterior thigh.
L3: the medial epicondyle of the femur.
L4: the medial malleolus.
L5: the dorsum of the foot at the third metatarsophalangeal joint.
S1: the lateral aspect of the calcaneus.
S2: at the midpoint of the popliteal fossa.
S3: at the horizontal gluteal crease (the horizontal crease formed by the inferior aspect of the buttocks and the posterior upper thigh).
S4/5: the perianal area

Question 7

After sensation

Answer 7

Proprioception
Vibration (128Hz)

Question 8

Coordination

Answer 8

Heel to shin test

Question 9

To conclude

Answer 9

THANK, OFFER TO HELP COVER, WASH HANDS
To conclude - full neuro exam (UL + CN), lower limb MSK + vascular