Gluteus medius and gluteus minimus muscles (L4, L5 and S1, superior gluteal nerve).
In an ambulant patient these muscles should be examined as follows:
- Ask the patient to stand on one leg.
- Note whether the patient’s upper body leans over the stance leg (positive sign of Duchenne [Figure 51]).
- Note whether the patient can keep the pelvis in a horizontal position (if not, this is a positive Trendelenburg’s sign [Figure 52]).
Both signs may indicate a loss of strength in the above-mentioned muscles of the stance leg.
Figure 51
fiigure 52
In a bed-ridden patient the muscles should be examined as follows:
- Carry out passive abduction on the leg to be examined.
- Ask the patient to maintain the leg in this position while you attempt to carry out adduction.
If the patient is not able to maintain abduction of the leg, it indicates loss of strength in the investigated muscles.
Iliopsoas muscles (Th.12, L1, L2, L3, femoral nerve)
- The patient should lie on the examination table and maintain the hip in maximum flexion (with knee against the chest).
- Try to bring the hip back to the neutral position [Figure 53].
Figure 53
Quadricep muscle (L2, L3, L4, femoral nerve)
- Place the patient’s outstretched leg on your forearm, with your hand resting on the knee of the opposite leg.
- Try to flex the leg at the knee [Figure 54].
Figure 54
Femoral adductor muscles (L2, L3, L4, obturator nerve)
- The patient should be lying down with flexed hips and knees, keeping the knees tightly together.
- Try to pull the knees apart [Figure 55].
Figure 55
Hamstrings (L5, S1, S2, sciatic nerve)
- The patient should be lying down, pulling their heels tightly against their buttocks.
- Try to extend the leg at the knee [Figure 56].
Figure 56
Anterior tibial muscle and extensor digitorum muscle (L4, L5, S1 and peroneal nerve)
- Have the patient lie down keeping the leg extended, and ask them to pull their forefoot towards them as far as possible.
- Try to flex the foot (i.e., move it away from the patient) [Figure 57].
Figure 57
Gastrocnemius muscle (L5, S1, S2, tibial nerve)
- Have the patient lie down keeping their leg extended, and pushing their forefoot away from them as far as possible.
- Try to extend the foot (i.e., move it towards the patient) [Figure 58].
Figure 58
Peroneal muscles
- Ask the patient to tilt the lateral edge of the foot upwards.
- Try to push it downwards [Figure 59].
Figure 59
Extensor hallucis longus muscle (L4, L5, S1, peroneal nerve)
- Ask the patient to extend their big toe towards them as far as possible.
- Try to flex the big toe [Figure 60].
Figure 60
Flexor hallucis longus muscle (S1, S2, tibial nerve)
- Have the patient flex the big toe as far as possible.
- Try to extend the toe [Figure 61].
Figure 61