Lower limb examination assesses the neurological function of the lower limbs. LL is shorthand for Lower limb.
Method
Remember with the mnemonic “The Powerful Romans Conquered Spain”:
REMEMBER to start- Walking:
Assess gait, asking patient to walk back and forth. Gait should be smooth, with quick turning. Then ask patient to do heel to toe
Romberg’s test, which is used for drunk driving, asking patient to stand with their feet together, and eyes closed. Your hands will be there to prevent them from falling
Ensure lower leg has adequate exposure
General inspection, looking for fasciculation, muscle wasting, tremor
Palpate, for muscle wasting and tenderness
Test tone, asking patient to:
Leg roll, rolling leg to either side
Leg lift, lifting up the leg at the knee, then dropping it, and seeing if heel remains in contact with bed
Ankle clonus, asking patient to lift knee outward to one side, and rapidly rotating foot in circles, before suddenly pulling the foot towards patient. More than 5 beats is abnormal
Test power, asking patient to:
Try to lift leg off bed, whilst placing hand just above knee cap
Bring legs so feet are flat, try pulling leg away from them, and pushing leg towards them
Push foot away and towards them
Same thing with big toe
Test reflexes, which can be enhanced by Jendrassik maneuver, asking patient to form a hook with both sets of fingers
Knee tendon test (aka knee jerk, KJ), lifting knee with one hand, hitting just below knee cap
Achilles tendon test (aka ankle jerk, AJ), hitting holding foot towards them, hitting back part of foot. If fails, can also hit them just below toes
Say that you could, do Babinski sign, running plastic object on outside aspect of soul
Test coordination, including:
Heel to shin test, starting from the knee running down shin
Foot tap, asking them to tap your hand with their foot AQAP
Test proprioception, asking if moving towards or away
Test sensation, including: Ask patient to close eyes, and indicate when they feel touch
Crude and pin prick (L3, L4, L5, S1)
Vibration sense (using lower 128Hz, when start feel vibration, and when stop), placing over bony prominence just below toe
Say that you could, do temperature (EXPLAIN: test lateral spinothalamic tract), upper limb exam, lower limb exam, MMSE
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