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Neurological Examination – Lower Limb

Source-faithful checklist for the neurological examination of the lower limb.

Neurology · Self-paced

Step 1. Introduction

  1. Hand hygiene

    Hand wash/rub

  2. Introduce yourself

    Introduce self

  3. Explain the purpose

    Explain purpose

  4. Consent

    Obtain consent

  5. Pain or limitation

    Ask about pain and limitation of movement

Step 2. General Inspection

  1. Orientation

    Orientation

  2. Comfort or distress

    Comfort/distress

  3. Posture

    Posture

  4. Wasting

    Wasting

  5. Tremor

    Tremor

  6. Fasciculations

    Fasciculations

  7. Skin changes

    Skin changes

  8. Report findings

    Report findings correctly

  9. Vital signs

    Comment on vital signs

Step 3. Gait and Balance

  1. Gait

    Gait

  2. Walking on heels

    Walking on heels (L4, L5)

  3. Walking on tiptoes

    Walking on tiptoes (S1, S2)

  4. Heel-toe walking

    Heel-toe walking

  5. Squat test

    Squat test

  6. Romberg's test

    Romberg's test

  7. Report findings

    Report findings correctly

  8. Myotome assessment limitation

    Students should be aware of (but need not report) the myotomes; may be tested in written exam.

Step 4. Tone, Active Movement Screening and Clonus

  1. Active movements

    Observe active movements

  2. Tone

    Assess tone at hip, knee and ankle

  3. Patellar clonus

    Patellar clonus

  4. Ankle clonus

    Ankle clonus

  5. Compare sides

    Test both sides and compare

  6. Report findings

    Report findings

Step 5. Power

  1. Hip flexion and extension

    Hip flexion (L1, L2) and extension (L5, S1)

  2. Hip adduction and abduction

    Hip adduction (L2, L3) and abduction (L4, L5)

  3. Knee extension and flexion

    Knee extension (L3, L4) and flexion (L5, S1)

  4. Ankle dorsiflexion and plantarflexion

    Ankle dorsiflexion (L4, L5) and plantarflexion (S1, S2)

  5. Tarsal inversion and eversion

    Tarsal inversion (L4, L5) and eversion (L5, S1)

  6. Compare sides

    Test both sides and compare

  7. Report findings

    Report findings correctly

  8. Myotome assessment limitation

    Students should know (but need not report) which myotome is tested with each movement; may be tested in written exam.

Step 6. Reflexes

  1. Patellar/knee jerk

    Patellar/knee jerk (femoral nerve – L3, L4)

  2. Ankle jerk/gastrocnemius

    Ankle jerk/gastrocnemius (posterior tibial nerve – S1, S2)

  3. Plantar reflex

    Plantar reflex (afferent: tibial nerve, S1 dermatome; efferent: sciatic nerve, L5, S1)

  4. Compare sides

    Test both sides and compare

  5. Report findings

    Report findings correctly

  6. Reflex-level assessment limitation

    Students should know (but need not report) which levels are tested with each reflex; may be tested in written exam.

Step 7. Coordination

  1. Heel-shin test

    Heel-shin test

  2. Toe-to-finger test

    Toe-to-finger test

  3. Rapidly alternating movements

    Rapidly alternating movements

  4. Compare sides

    Test both sides and compare

  5. Report findings

    Report findings correctly

Step 8. Light Touch Sensation

  1. Demonstrate with a reference point

    Demonstrate using reference point

  2. L2

    L2 mid-anterior thigh

  3. L3

    L3 medial femoral condyle

  4. L4

    L4 medial malleolus

  5. L5

    L5 dorsum of foot over 3rd MTP joint

  6. S1

    S1 lateral heel

  7. S2

    S2 popliteal fossa

  8. Compare sides

    Test bilaterally and compare; ask if sensation is the same on both sides

  9. Report findings

    Report findings correctly

  10. Additional dermatome sites — comment only

    Comment only on where to test T12 (midpoint of inguinal ligament), L1 (halfway between T12 and L2), S3 (ischial tuberosity) and S4–5 (peri-anal region)

  11. Dermatome assessment limitation

    Students should know (but need not report) which dermatome is tested at each level; may be tested in written exam.

Step 9. Pain Sensation

  1. Demonstrate with a reference point

    Demonstrate using reference point

  2. Dermatomes

    Same dermatomes as light touch (L2–S2)

  3. Sharp/dull technique

    Correct technique using sharp/dull

  4. Neurotip disposal

    Correct disposal of Neurotip (if using)

  5. Compare sides

    Test bilaterally and compare; ask if sensation is the same on both sides

  6. Report findings

    Report findings correctly

  7. Additional dermatome sites — comment only

    Comment only on where to test T12, L1, S3 and S4–5

  8. Dermatome assessment limitation

    Students should know (but need not report) which dermatome is tested at each level; may be tested in written exam.

Step 10. Vibration Sensation

  1. Explain to the patient

    Explanation to patient

  2. Technique

    Appropriate technique

  3. Compare sides

    Compare both sides

  4. Report findings

    Report findings correctly

Step 11. Proprioception

  1. Explain to the patient

    Explanation to patient

  2. Technique

    Appropriate technique

  3. Compare sides

    Compare both sides

  4. Report findings

    Report findings correctly

Step 12. Conclusion

  1. Thank the patient and allow redressing

    Thank patient and indicate they may redress

  2. Communication

    Appropriate communication

  3. Hand hygiene

    Hand wash/rub

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