Definition of "Lower limb examination"

Last modified: 6 days



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
See also

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Definition of Lower limb examination | Autoprac


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