The Lower Limb Neuro Exam
The neurological examination of the lower limb is used to assess for motor, sensory, cerebellar and other pathology affecting the central or peripheral nervous system.
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Skin
Cafe au lait spots, neurofibromas
Posturing
Decorticate (flexion) / decerebrate (extension)
Muscles
Wasting, fasciculations
Tremor
Resting / postural / intention / psychogenic
Rhythmic involuntary vibration of 1+ body parts
Chorea
Abrupt irregular movements
Dystonia
Contractions resulting in abnormal posture
Myoclonus
Shock-like jerking movements
Tics
Suppressible stereotyped movements preceded by urge
Feet
Foot drop, pes cavus
Upper Motor Neuron Weakness
Cerebrum, brainstem or spinal cord pathology
Lower Motor Neuron Weakness
Spinal root, lumbar plexus or peripheral nerve pathology
Upper and Lower Motor Neuron Weakness
Classically motor neurone disease (ALS)
Proximal Weakness
More commonly muscular in aetiology
Distal Weakness
More commonly neurologic in aetiology
Tone
Passive movement of hips, knees, ankles
Clonus
Rotate then sharply dorsiflex the ankle
Power
0/5 no flicker, 3/5 vs. gravity, 5/5 normal
Movement against gravity & resistance, R vs. L
Reflexes
0 no response, 2+ normal, 3+ brisk, 4+ very brisk
Patellar, ankle, Babinski ± reinforcement
Babinski Sign
Run a key up lateral aspect of sole of foot