Lower Limb Neurological Examination - OSCE guide (old version) | UKMLA | CPSA

This video demonstrates how to perform a lower limb neurological examination in an OSCE station, including assessment of gait, tone, power, reflexes and coordination.

Check out our other awesome clinical skills resources, including:

Chapters:
- Introduction 00:00
- General inspection 00:33
- Gait 00:52
- Romberg’s test 01:36
- Tone 01:49
- Power 02:21
- Reflexes 04:09
- Fine touch and pin-prick sensation 05:12
- Vibration sensation 06:22
- Proprioception 07:03
- Co-ordination 07:38
- Summary of findings 08:37

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Always adhere to your medical school/local hospital guidelines when performing examinations or clinical procedures. DO NOT perform any examination or procedure on patients based purely upon the content of these videos. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video.

Some people have found this video useful for ASMR purposes.

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[kartace]

Testing sensation is often misunderstood:
1. Crude (pressure) touch - carried in both dorsal column-medial lemniscus (DCML) AND the Spinothalamic tract (STT)
2. Fine - carried in the DCML only
3. Pain/temperature - carried in the STT only
- So when you're testing sensation you want to be able to discriminate between these two pathways (DCML/STT), because they're different anatomical areas of the spinal cord, so different injuries produce different clinical signs.
- This means that when you're testing sharp/blunt discrimination. You need to ask the patient to tell you whether the sensation is 'sharp or blunt', because this tells you if their STT is working. If they simply say 'yes i can feel that' then you don't know if they percieved a sharp sensation or a blunt sensation and all you know is that their crude sensation is intact so that means either the DCML OR the STT are working, but one or the other may still be broken.
- Equally, when you're testing fine touch sensation, it really does need to be fine touch rather than pressure, or you won't be isolating the DCML and you may be getting some crude touch (pressure) sensation crossover from the STT.
- Finally the reason we test proprioception/vibration and temperature is because in neurological injury/disease these sensations are generally lost before pain/fine touch/crude touch, and so it makes our examination more sensitive to the earlier stages of peripheral neuropathy, for example.

[tutoringwithbecky]

Thanks for all the great videos! By the way, a neurologist told me that when testing tone with leg lift, the aim is not to drop the leg and see it bounce, it's to look at the heel as you lift the leg. If the heel leaves the bed, the leg is hypertonic, if it slides up the bed then the leg has normal or reduced tone. You can then place the leg down rather than dropping it. It's nicer to the patient, if anything!

[tfoprincess]

If the doctor asked me to walk normally, I'd trip from awkwardness.

[iroowu]

Thank you all for preparing everybody's examination effectively!!

[omdgymx]

thanks for getting me through 5 years of medical school!

[amulyapremkumar]

i love these videos! I hope to be that tension free in examining, one day.
p.s. The patient kept looking at the doctor with an expression that seemed like, "I wish to show my best, i wish the doctor feels proud of my abilities!" Also, how i wish all patients had such a cute smile and all doctors did their examination so effortlessly.
regards,
a medical student in the making.

[ramilchow]

Med student from Sydney. Love these videos. U guys are legends!!

[phantasm]

A very thorough neurological examination of the lower extremities. Thank you!

[VinnithPullavarayar]

In checking tone with leg roll your eyes should be fixed on the movement of the foot. You have to roll slowly and increase the speed.
Normal: foot follows rotation of leg under slow motion, unable to follow ( lags ) in fast motion
LMN lesion: foot not able to follow leg rotation in both slow and fast motion.
UMN lesion: foot able to follow leg rotation in both slow & fast motion.

Leg drop:
Normal: Leg drops quickly + at same spot
LMN lesion: Leg drops quickly + sideways ( different spot )
UMN lesion: Leg drops slowly + same spot.

[DrArobinson]

Great videos guys. As for the proximal muscle weakness it needs to be from a lower starting height to truly assess.

[DrAdilRamzan]

thank you. tomorrow is my long case .. so watching your videos. i noticed you did the heel to shin test differently. . . ! anyways nice job. thankyou.

[elizclark]

Very thorough assessment. The patient is so fit.

[preloshmoodley]

In the midst of my medical board exam part 2, these videos are a God send. Thank you.

[zywoomeister]

View outside the window looks like a wallpaper, until we see the cars passing by.. Amazing video & view. Thank you!

[joaoeduardo]

Med Student from Brazil. You guys are awesome, keep it up!!!

[FrankieG-M]

Got my finals tomorrow. My whole day will be rewatching all these videos 😂

[BibekTimilsina]

@Geeky Medics
As a Suggestion only, while eliciting the plantar reflex one shouldn't keep running the blunt end till the end; what I read was to stop after you get the reflex!!!

[rumit]

love the bird sounds in the background

[humansofmedicine]

By far the best peripheral neuro exam.

[axmed]

My reference of physical examination. Thank you guys.