Lower Limb Neurological Examination

Introduction0/5

• Greetings
• Hand wash
• Verify the patient's identity using at least two or three details
• Explanation
• Consent

Inspection0/4

• Posture
• Muscle wasting
• Skin changes
• Whether there are any equipments

• GaitAsk patient to walk heel-to-toe. Observe for ataxic, parkinsonian, high-stepping, waddling, hemiparetic, or spastic paraparesis gait patterns.
• Romberg's testPatient stands with feet together, arms by sides, eyes closed. Positive if falling without correction, indicating sensory ataxia. Swaying with correction is not positive.
• Tone
  • Gently wobble the limbFoot should flop side to side
  • Lift under the knee suddenlyRelaxed limb should keep ankle on couch
  • Clonus of the anklePresent with Upper Motor Neurone (UMN) lesions
• Power (test symmetrically)Use MRC scale: 0 (no contraction) to 5 (normal power).
  • Hip flexion (L2/3), extension (L5, S1/2)
  • Knee flexion (L5/S1), extension (L3/4)
  • Ankle plantar-flexion (S1/2), dorsiflexion (L4/5)
  • Big toe extension L5
• Co-ordination
  • Heel-shin testPatient places heel on opposite knee, slides down tibia to ankle, lifts and repeats. Test both sides.
  • Foot tapping testPatient taps sole of foot quickly on examiner's hand. Test both sides.
• Sensation
  • Pain and temperatureUse pin. Demonstrate on sternum first. Start distally, work proximally, test each dermatome, compare sides.
  • Vibration and proprioceptionFor vibration, use tuning fork on MTPJ of great toes. For proprioception, move DIPJ of great toe, patient reports direction with eyes closed.
  • Light touchUse cotton wool with dabbing motion. Start distally, work proximally, test each dermatome, compare sides.
    • L2
    • L3
    • L4
    • L5
    • S1
• ReflexesClassification: absent, + (reduced), ++ (normal), +++ (increased). Use reinforcement (e.g., hand gripping) if needed.
  • Knee jerkL3/4
  • AnkleS1/2
  • Plantar reflexL5/S1/2. Look for first movement of first MTP, should be down-going. Extensor response indicates UMN lesion.
• Wash hands