Lower limb sensory motor examina1on
MC 3481 Umer Farooq
A#er brief intro & consent adequately expose pa7ent ( upto umblicus ideally)
Remember to asses 7 things in lower limb as follows
Remember from bed end and from right side of
Inspec7on: pa2ent
1-Scar marks
2-Muscle was7ng( ideally, use measuring tape ) LMN lesion mainly cause was7ng 7ent as well
Myoclonic e.g.(in epilepsy& neurodegenera7ve
disorder)
3-Involuntary movements Dystonia e.g ( tor7collis)
Chorea (purposeless movement)
Athetosis ( like con7nuous wri7ng movement)
Blallism( violent Ugh7ng movements)e.g
hemiballismus
Tics ( repita7ve movement can be suppressed by
pa7ent for brief 7me)
4-Fasicula7on
Postural tremors: e.g.(physiologiocal/
drugs(caXeine,nico7ne)/alcohol
5-Tremors: withdrawal/inc.metabolism/essen7al>donate
autosomal dominant)
Res7ng tremors
e.g ( parkinsonism – pill rolling /drug indused
parkinsonism/supranuclear palsy)
Ac7on tremors
e.g (cerebellar lesion>stroke,mass/mul7ple sclerosis/
chronic alchol abuse
e.g
Flexion deformi7es
6-Deformity Pes cavus ( high harched foot)
TONE/RIGIDITY ( checked by passive movement by WAYS TO CHECK:
examiner) 1- Leg roll from side to side
2-Leg li# from side to side
3-Ankle colonus
Power of limbs:
Hip
Hip Flexion((L1,2)
Hip extension(L5,S1)
Adduc7on(L2,3)
Abducion(L4,5)
Knee
Knee bexion (S1)
Knee extension(L3,4)
ANKLE
Ankel dorsi Flexion(L4)
Ankel plantar bexion(S1,2)
Ankel inversion (L4)
Ankel eversion(L5,S1)
BIG TOE
Extesor hallusis longis/big toe(l5)
If any dicculty do jandraskis menouver ( ask
REFLEXES pa7ent to inter lock Ungures and pull one had
against other or clench their teeth)
1-KNEE( l3/4)
2-ANKEL(L5/S1)
3-PLANTER(S1) asses only Frst response
Good to remember dermatomes ( importance is
Sensa1ons : if you know pathology in which dermatome you
can localize lesion in spinal cord)
1-Crude touch
2-Fine touch
3-Vibra7on
4-Propriocep7on
Coordina1on
1-Heel shin test
Abnormal in midlilne cerebellar lesion(vermis)
( always stand aside of pa7ent prevent them from
any injury)
2-Tendem walk
3-Rombergs test
Gait test
Look for any proximal weakness Ask him to stand uop with out using your hands
Look for
1-Speed(parkinsonan gait)
2-Symmetry
( to rule out limping)
3-Arm swing
4-Balance( for celleber assessment)
1-Walk on toe 7p only Common peroneal nerve damage cause
Walk on heel only dicculty in both of these tests
