Lower Limb Exam

Introduction

Wash Hands Introduce yourself and your role to the patient Explain the purpose of the exam and what it entails to patient Obtain consent

General Inspection

Pain or distress Scars Wasting Fasciculations Tremors Dyskinesia Walking aids

Gait

Ask the patient to walk 5m and return.

Comment on: Speed Symmetry Stride: length and clearance Turning circle

Tandem Gait

Ask patient to walk 5m heel to toe, placing one foot directly in front of the other. This tests cerebellar function.

Romberg's Test

Tests proprioception and vestibular function

Stand close to the patient, ready to catch the patient if they lose balance. Ask the patient to stand still, keeping their legs together, hands by their side and eyes closed.

A positive Romberg's test is if the patient falls.

Tone

Ask patient to lie on the bed and relax their leg muscles.

Assess tone of muscles responsible for movement at hip, knee and ankle joints.

Roll each leg to assess hip rotator muscles

Quickly lift each knee off the bed, watching whether the patient's heels remain in contact with the bed. Increased tone will cause the patient's heel to rise off the bed.

Circumduce each foot at the ankle testing tone for flexion, extension, abduction and adduction.

(hypertonic-normotonic-hypotonic)

Clonus With the patient relaxed and leg slightly flexed at the knee and ankle joints, swiftly dorsiflex the foot. Clonus describes a rhythm containing greater than 5 involuntary contractions of the gastrocnemius muscle following this.

Power

Isolate the joint and use your hand to oppose the tested movement.

Hip

Flexion(L2, L3)

Extension(L4, L5)

Knee

Flexion(L5, S1)

Extension(L3, L4)

Ankle

Dorsiflexion(L4, L5)

Plantarflexion(S1, S2)

Reflexes

Knee Jerk (Patellar) (L3, L4)

Ankle Jerk (Achilles) (S1, S2)

Plantar Jerk (Babinski) (L5, S1)

Coordination

Heel to Shin

Ask the patient to repeatedly slide the heel of their left foot along their right shin for the full length. Repeat this for the other foot.