LOWER LIMB EXAMNATION

Expose the lower limbs up to thighs.

Get the patient closer to your side of the bed.

Inspection:
 Abnormalities in the posture
 Wasting of thighs, legs and feet separately
 Fasciculation (in the areas where muscles are not wasted)
 Scars, ulcers
 Tropic changes ( e.g. nails)
 Callosities, hammer toe… etc
 Tremors.

Tone:

 Global tone


Power:
Hip joint
 Raise the leg without bending from the knee joint.

 Flexion/extension

 Abduction/adduction

 Internal and external rotation

Knee joint
 Flexion/extension
Ankle joint
 Dorsiflexion/palmer

 Iverson/eversion.

Power of the big toe

Reflexes:
Knee jerk
 Bend the knees and lift from one hand.
 Keep one finger in between the knees to prevent touching both
legs together.
 Tap from the tendon hammer using the other hand to the patella
tendon.

Ankle jerk
 Bend from the knee joint.
 Hold the foot from one hand and move up and down (dorsi and
palmer flexion) until you feel the Achilles tendon tension is
neutral.
 Tap to the Achilles tendon using the tendon hammer.

 Ask the patient to relax the limbs.

 Make sure you compare both sides.
 If the reflexes can not be elicited, reinforcement has to be done.
Up going plantar reflex:
 Explain the patient what you going to do
 Lift the leg and hold it from one hand.
 Draw a line using a key on the plantar surface of the foot.

Clonus:
Patella clonus:

Ankle clonus:

 Do not elicit clonus when reflexes are absent.

Coordination:
 Draw a circle on air without bending from the knee joint.

 Heel knee shin test.

 Penduler knee jerk

 Ask the patient sit across the bed.
 If the foot is touching the floor lift it from the knee joint with
one hand and tap to the patella tendon using a tendon hammer
with the other hand.

 Romberg sign.
 Ask the patient to stand straight and observe.
 Ask the patient to close the eyes and observe.

 Heal to toe test

 Ask the patient to walk by touching the heel of a one foot
with the big toe of the other foot.

Gait:
 Ask the patient to walk and observe the gait.