Leg Weakness / Sensory Loss

 

 

Common Examination Components:

(You are likely to be expected to examine the common components in each case)

 

Introduction for the patient e.g. ‘What you have told me suggests I need to examine your leg. Can you take your bottom layers off so I can see your leg clearly’ 
 


Inspection: (ensure the leg is exposed to the groin crease).

  • Tremor
  • Muscle Wasting
  • Bony Abnormality
  • Fasciculation


Tone for rigidity

 

Power

  • L1,2 - hip flexion   - Pull your knee to your tummy

 

  • L1,2 - knee flexion   - Pull your heel to your bottom

 

  • L3,4 - knee extension - Push your heel to the end of the bed’

 

  • S1    - planter flexion - Push against my hand

 

  • L4,5 - dorsi flexion -  Push against my hand.

 

Reflexes

  • S1,2 (Ankle),

 

  • L3,4 (Knee)


 

Sensation:  Light Touch  

‘Please close your eyes and let me know when you can feel me touching your leg. Let me know if anywhere I touch you feels different.’
 
Touch once in the dermatomes L1,2,3,4,5, S1. Keep the timing of touches unpredictable to help prevent guesswork by the patient.

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Physical Examination

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Additional Examination Components:

(Examine an additional component If the specified indication is present)

 

Indication: History or examination findings suggestive of sensory loss or conditions associated with dorsal column disease

 

Components: Proprioception and Vibration

 

 

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