How would you explain this exam to your patient?
Hello, my name is ……. I am a first year PA student.
Can I take your full name and DOB please?
How would you like to be addressed?
Today I have been asked to perform an exam of the nerve of your legs. This will involve me looking at your legs, moving them as well as assessing sensation and reflexes.
Would it be okay to examine you this way?
Before i begin, are you in any pain or discomfort.
What do you look for when conducting a general inspection?
- Sticks
- Walking frames
- Medication
- Scars
- Involuntary movements
- Muscle wasting
- Fasciculations
What structure do you follow when performing this exam?
- Tone
- Power
- Coordination
- Sensation
- Reflexes
How do you assess tone of the lower legs?
- Leg roll
- Knee drop
- Ankle clonus
How do you assess power of the lower legs?
- Up
- Down
- In
- Out
- Bend knee -> towards bottom
- Straighten leg
All above with resistance
How do you assess sensation of the lower legs?
- Light touch
- Pin prick
- Vibration
- Propioception
Which dermatomes do you check sensation on?
L2 L3 L4 L5 S1 S2
How do you assess propioception in lower limb?
Move the toe up and down and ask the patient where it is
Make sure the patient’s eyes are closed
How many reflexes are there for lower limb?
3
- Knee jerk
- Ankle reflex
- Babinski reflex
What examination would you offer after this exam?
Vascular examination
