Lower limb examination assesses the neurological function of the lower limbs. LL is shorthand for Lower limb.

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

• Upper limb
• Neurological exam