Lower Limb Neurological Exam

Front 1

If you were doing a neurovascular exam of the feet, what nerves would you be testing?

Back 1

L4, L5, S1

Front 2

Describe the L4 dermatome

Back 2

Big toe and the foot proximal to this (volar and dorsal side), medial calf to knee

Front 3

Describe the L 5 dermatome

Back 3

Middle 3 toes and the foot proximal to this (volar and dorsal, although avoids the heel), lateral calf to knee

Front 4

Describe the S1 dermatome

Back 4

1 Silly little toe! And the foot proximal to this, the heel (+ a touch higher in the midline calf)

Front 5

What nerves allow (a) standing on tiptoes (b) standing on heels (c) squat and stand up again

Back 5

(a)Toes = S1 (b) Heels = L4, L5 (c) squat= L3, L4

Front 6

What nerves are involved in the (a) knee jerk (b) ankle jerk (c)plantar reflex?

Back 6

(a) Knee jerk- L3, L4 (b) 2 silly ankle jerks - S1, S2 (c)L5, S1, S2

Front 7

What are the four mail peripheral nerves in the leg?

Back 7

Lateral cutaneous nerve of the thigh, femoral nerve, sciatic nerve, common peroneal nerve

Front 8

How would lateral cutaneous nerve entrapment present? Where would it get trapped?

Back 8

Numbness (+ or - pain) over anteriorlateral thigh. No motor issues.

Front 9

What is the differential diagnosis for lateral cutaneous nerve entrapment and how can dermatomal testing help?

Back 9

Similar area to L2, but L2 dermatome sweeps over the lateral buttock to the lumbar spine. (The lateral cutaneous nerve does not supply the buttock at all).

Front 10

The femoral nerve is supplied by which lumbar nerve roots?

Back 10

L2, L3, L4,

Front 11

What area will be numb in a femoral nerve lesion?

Back 11

(numbness over medial knee and a good 10cm above and below this; note, L3 and L4 dermatomes supply this area and meet at the knee)

Front 12

What weakness would you find and reflex deficits in a femoral nerve lesion?

Back 12

Absent knee jerk and week knee extension (+ slight hip flexion weakness)

Front 13

What nerves supply the sciatc nerve?

Back 13

L4-S2

Front 14

What muscles does the sciatic nerve supply?

Back 14

Hamstrings + everything below the knee

Front 15

What is the sensory distribution for the sciatic nerve?

Back 15

Entire posterior thigh+leg +entire volar foot (impaired with a proximal lesion)

Front 16

What motor deficits would you get with a sciatic nerve lesion?

Back 16

Footdrop, knee flexion weakness

Front 17

What reflexes would be affected by a sciatic nerve lesion?

Back 17

Absent plantar reflex, intact knee jerk.

Front 18

DDx foot drop (8)

Back 18

Common peroneal nerve palsy, sciatic nerve palsy, lubrosacral plexus lesion, L4/L5 root lesion. Peripheral motor neuropathy, distal myopathy, motor neuron disease, stroke.

Front 19

What nerves supply the common peroneal nerve?

Back 19

L4, L5, S1

Front 20

What is the relationship between the sciatic and common peroneal nerve?

Back 20

CPN is the terminal branch of the sciatic nerve

Front 21

What sensory area does the common peroneal nerve cover?

Back 21

Entire dorsal foot (esp. medial side) and lower anterior leg to mid-shin

Front 22

What motor deficits will a common peroneal nerve lesion cause?

Back 22

Foot drop, weak dorsiflexion and eversion.

Front 23

What reflex would be affected by a common peroneal nerve lesion?

Back 23

None

Front 24

What does an L5 nerve root lesion cause?

Back 24

Weakness of knee flexion and foot inversion

Front 25

What sporting injury may cause a common peroneal nerve lesion?

Back 25

Colateral ligament tear of the knee

Front 26

What injury can cause a permanent sciatic nerve palsy?

Back 26

Hip dislocation

Front 27

What is the differential diagnosis for a foot drop? (Stroke, 4 lesions, 3 diseases)

Back 27

[1] Common peroneal nerve palsy, sciatic nerve palsy, lumbrosacral plexus lesion, L4, L5 lesion [2] Peripheral motor neuropathy, distal myopathy, motor neuron disease

Front 28

What steps would you take in examining gait (4)?

Back 28

[1] Normal gait with a turn [2] Heel-toe (midline cerebellar lesion) [3] tip toe (s1) [4] heel walk (L4 or L5)

Front 29

What 2 tests might you do while examining gait?

Back 29

[1] Romberg (proprioceptive loss; if unstead before closing eyes, vestibular or cerebellar dysfunction) [2] stand from squat or sitting

Front 30

Describe the gait of hemiplegia

Back 30

Foot drop, leg swung in a lateral arc

Front 31

Describe the gait of spastic paraparesis

Back 31

Scissor gait

Front 32

Describe the gait of parkinsons

Back 32

Hesitancy starting, shuffling, freezing, festination, propulsion, retropulsion

Front 33

Describe the gait of a cerebellar lesion

Back 33

A drunken wide-based gait or reeling on a narrow base, staggers towards affected side

Front 34

Describe the gait of a posterior column lesion

Back 34

Clumsy slapping down of the feet on a broad base

Front 35

Describe the gait of footdrop

Back 35

High-stepping gait

Front 36

Describe the gait of proximal myopathy

Back 36

Waddling

Front 37

Describe the gait of prefrontal lobe lesion (apraxic)

Back 37

Feet appear glued to floor (but move more easily when pt is supine)

Front 38

Describe the gait of a functional movement disorder

Back 38

Bizzare and inconsistent