Flashcards in LOWER LIMB EXAMINATION Deck (49)
How would you start any examination?
Expose the patient
Reposition the patient
Ask if they are in any pain or discomfort
How exposed should the patient be for the lower limb neurological examination?
Their lower limbs should be bare however, to preserve patient dignity, their underwear should be left on.
How should the patient be positioned for the lower limb neurological examination?
Lying down at 45 degrees
What are you looking for during your inspection of the upper limb in the neurological examination?
From the end of the bed:
Any pain or discomfort
Any walking aids or signs of chronic discomfort
Wasting of muscles
When inspecting the foot as part of the neurological exam of the lower limb, what would a high arch of the foot, lack of muscle and claw toes be signs of?
Having inspected the patient as part of a lower limb neurological exam, what is the next thing to assess?
When assessing tone as part of an lower limb neurological exam, what must you ask before starting your assessment?
Whether they are in any pain at all.
How do you assess tone in a neurological exam of the lower limb?
Ask patient to relax/go floppy like a rag-doll.
Passively flex and extend the limb.
Roll the leg to look for a slight lag. No lag indicates rigidity or increased tone.
Passively lift the knee from below and then drop it. Heel should stay on the bed. If not there is increased tone.
Test for clonus in the ankle.
You are looking for increased (rigidity/spasticity) or decreased tone.
When might the tone of the lower limb be increased?
Upper motor neuron lesions
Basal ganglia dysfunction (Parkinson's disease)
When might the tone of the lower limb be decreased?
Lower motor neuron lesions
How do you test for ankle clonus in the lower limb examination?
Plantar flex the foot a few times then quickly dorsi flex and hold. Looking for more than 5 beats of plantar flexion.
What is ankle clonus indicative of?
Upper motor neurone lesion
Having assessed the patient's muscle tone as part of an lower limb neurological exam, what is the next thing to assess?
What are the different movements that you assess the power of during an lower limb exam? For each movement say which muscle group or spinal nerve is being tested.
Hip flexion - L1, L2
Hip extension - L5, S1
Hip adduction - L2, L3
Hip abduction - L4, L5
Knee flexion - S1
Knee extension - L3, L4
Ankle dorsiflexion - L4
Ankle plantarflexion - S1, S2
Extension of big toe - L5
Ankle inversion - L5
Ankle eversion - L5, S1
What scale is power measured on when assessing the neurological status of the lower limb?
MRC scale for power
What are the different levels on the MRC power scale used during a neurological exam of the lower limb?
0 - No muscle contraction is visible.
1 - Muscle contraction is visible but there is no movement of the joint.
2 - Active joint movement is possible with gravity eliminated.
3 - Movement can overcome gravity but not resistance from the examiner.
4 - The muscle group can overcome gravity and move against some resistance from the examiner.
5 - Full and normal power against resistance.
Does reduced power of any muscle group indicate upper or lower motor neuron lesions?
During a neurological examination of the lower limb, what do you test having assessed the patient's power?
What are the three reflexes to test in the lower limb? State which nerve(s) is/are being tested for each one.
Knee jerk - L3, L4
Ankle - L5, S1
Plantar reflex - L5, S1, S2
When testing the plantar reflex in the lower limb exam, what is the normal reflex?
Plantar flexion of the foot
What do we call it when the patient's foot dorsiflex's when testing the plantar reflex in the lower limb exam?
A positive Babinski sign
What is the Babinski sign indicative of?
An upper motor neuron lesion
What might a hyperreflexia in the lower limb be indicative of?
An upper motor neuron lesion
What might a diminished or absent reflex in the lower limb be indicative of?
A lower motor neuron lesion
If you having trouble eliciting a reflex during an lower limb examination, what can you ask the patient to do?
'Reinforcement' (the Jendrassik manoeuvre) - Ask the patient to clench their teeth together while you try to elicit the reflexes again.
Having assessed the tone, power and reflexes in the lower limb, what might you next assess before moving on to sensation?
How would you assess coordination as part of a neurological examination of the lower limb?
What are you testing when you assess coordination as part of a neurological examination of the lower limb?
The cerebellum. Dysdiadochokinesia (impaired ability to perform rapid, alternating movements) is a sign of cerebellar damage.
Also looking for intention tremors - indicative of multiple sclerosis.
When assessing the sensitivity of the lower limb to light touch, what must you first do?
Ask the patient to close their eyes and touch the sternal angle with the cotton wool to show them what it should feel like.