Lower limb motor examination

1-

2-

Introduction:
a.

Wash hands

b.

Introduce yourself

c.

Check patient details name/DOB

d.

Explain the examination

e.

Gain consent

f.

Expose patients legs shorts are most appropriate

g.

Ask if the patient has any pain anywhere before you begin!

General inspection
a.

Observe for clues around the bed wheelchair / walking stick etc

b.

General appearance any limb deformity or posturing?

i. Scars
ii.

Wasting of muscles

iii.

Involuntary movements dystonia, chorea, myoclonus

iv.

Fasciculations: relax the patient leg

v. Tremor parkinsons disease / benign essential tremor

vi.
3-

Posture

Gait:
a.

Ask patient to walk to the end of the room & back assess speed, symmetry &
balance

b.

Tandem (heel-to-toe) gait ask to walk in a straight line heel-to-toe an abnormal

heel-to-toe test may suggest weakness, impaired proprioception or a cerebellar
disorder

c.

Heel walking assesses dorsiflexion power

d.

Toe walking

e.

Rombergs test

i. Ask patient to stand with their feet together and eyes closed
ii.

Observe the patient (ideally for 1 minute)

iii.

Positive test loss of balance (swaying/falling over)

iv.

This suggests a sensory ataxia (defective proprioceptive or vestibular

system)

v. Its important to stand close by the patient during this test to stop them
falling over!

4-

Tone:
a.

Place your hand under a chosen knee abruptly pull it upward to flex it.

b.

Support the thigh and flex and extend the knee to feel if there is resistance

c.

Sit the ptn on the edge of the bed and raise his leg to horizontal plane then suddenly let it go

i. Normally it will oscillate a few

d.

Leg roll roll the patients leg & watch the foot: it should flop independently of the leg

e.

Ankle clonus

i. Position the patients leg so that the knee & ankle are 90 flexed
ii.

Rapidly dorsiflex & partially evert the foot

iii.

Keep the foot in this position

iv.

Clonus is felt as rhythmical beats of dorsiflexion/plantarflexion (>5 is

abnormal)

5-

The power:
a.

Assess one side at a time & compare

b.

Remember to stabilise the joint whilst testing

c.

Hip

i. Flexion (L1/2) raise your leg off the bed & stop me from pushing it down

d.

ii.

Extension (L5/S1) stop me from lifting your leg off the bed

iii.

Abduction (L4/5) move your leg away from the midline

iv.

Adduction (L2/3) stop me from moving your leg away from the midline

Knee

i. Flexion (S1) bend your knee, now stop me from straightening it

ii.
e.

Extension (L3/4) stop me from bending your leg

Ankle

i. Dorsiflexion (L4) point your toes towards your head & dont let me push them down

f.

ii.

Plantarflexion (S1/2) press down on my hand with the sole of your foot

iii.

Inversion (L4) push your foot against my hand

iv.

Eversion (L5/S1) push your foot out against my hand

Big Toe

i. Extension (L5) dont let me push your big toe down

6-

Reflexes
a.

Knee jerk (L3/4)

b.

Ankle jerk (L5/S1)

c.

Plantar response (S1):

i. Run a blunt object along the lateral edge of the sole of the foot, moving towards the little toe

7-

ii.

Observe the great toe

iii.

Normal result = Flexion of the great toe & flexion of the other toes

iv.

Abnormal (Babinski sign) = Extension of the great toe UMN lesion

Coordination:
a.

Heel shin test

b.

Toe finger test

c.

Foot taping test

THANK the patient