Lower Limb Motor Exam

September 22, 2015 Print Friendly Version of this page Print Get a PDF version of this webpage PDF
Introduces self
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1

Confirms name & age of patient
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1

Explains & gains consent
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1

Checks pain/numbness/paraesthesia/handedness
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1

Exposes patient from waist down
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1

General inspection for walking aids, deformities, asymmetries, resting tremor, dyskinesia
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1

Closer inspection for fasciculations, cafe au lait spots, scars, wasting
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1

Checks tone in all muscles with patient relaxed. Checks for cogwheel rigidity
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1

Checks for clonus
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1

MRC graded power of extension and flexion at the hip
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1

MRC graded power of extension and flexion at the knee
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1

MRC graded power of plantar and dorsiflexion
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1

MRC graded power of extension and flexion of the toe
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1

Knee jerk reflex using reinforcement if needed
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1

Ankle jerk reflex using reinforcement if needed
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1

Babinksi reflex
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1

Tests coordination with heel shin test
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1

If able asks patient to stand, then stand on toes and heels supporting patient throughout
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1

Assesses patient gait
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1

Thanks patient and offers help to redress
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1

Washes hands
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1

Requests full neurological exam
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1

Summarises appropriately with only key findings
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1

Offers appropriate differential diagnoses
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1

Patient global score
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1
2
Potential differentials
  • Stroke
    • Walking aids
    • Flexed upper limb and extended lower limb posturing
    • Spastic rigidity 
    • Unilateral upper motor neurone lesion
  • Gait & Coordination abnormalities (see G&C examination for differentials)
  • Bilateral weakness
    • Multiple sclerosis (may be asymmetrical)
    • Spinal cord compression
    • Motor neurone lesion (no sensory component)