{"id":175,"date":"2010-06-09T09:53:45","date_gmt":"2010-06-09T08:53:45","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/lower-limbs\/"},"modified":"2023-01-12T00:23:13","modified_gmt":"2023-01-12T00:23:13","slug":"lower-limbs","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-neurological-examination\/motor-function\/lower-limbs\/","title":{"rendered":"Lower limbs"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/116863987?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<p><em>Gluteus medius and gluteus minimus muscles<\/em> (L4, L5 and S1, superior gluteal nerve).<\/p>\n<p>In an ambulant patient these muscles should be examined as follows:<\/p>\n<ul>\n<li>Ask the patient to stand on one leg.&nbsp;<\/li>\n<li>Note whether the patient\u2019s upper body leans over the stance leg (positive sign of Duchenne [Figure 51]).<\/li>\n<li>Note whether the patient can keep the pelvis in a horizontal position (if not, this is a positive Trendelenburg\u2019s sign [Figure 52]).<\/li>\n<\/ul>\n<p>Both signs may indicate a loss of strength in the above-mentioned muscles of the stance leg.<\/p>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-164\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-51.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-51.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-51-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 51<\/span><\/span><\/p>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-165\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-52.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-52.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-52-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">fiigure 52<\/span><\/span><\/p>\n<p>&nbsp;In a bed-ridden patient the muscles should be examined as follows:<\/p>\n<ul>\n<li>&nbsp;Carry out passive abduction on the leg to be examined.<\/li>\n<li>Ask the patient to maintain the leg in this position while you attempt to carry out adduction.<\/li>\n<\/ul>\n<p>If the patient is not able to maintain abduction of the leg, it indicates loss of strength in the investigated muscles.<\/p>\n<p><em>Iliopsoas muscles <\/em>(Th.12, L1, L2, L3, femoral nerve)<\/p>\n<ul>\n<li>The patient should lie on the examination table and maintain the hip in maximum flexion (with knee against the chest).<\/li>\n<li>Try to bring the hip back to the neutral position [Figure 53].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-166\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-53.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-53.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-53-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 53<\/span><\/span><\/p>\n<p><em>Quadricep muscle <\/em>(L2, L3, L4, femoral nerve)<\/p>\n<ul>\n<li>Place the patient\u2019s outstretched leg on your forearm, with your hand resting on the knee of the opposite leg.<\/li>\n<li>Try to flex the leg at the knee [Figure 54].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-167\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-54.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-54.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-54-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 54<\/span><\/span><\/p>\n<p><em>Femoral adductor muscles <\/em>(L2, L3, L4, obturator nerve)<\/p>\n<ul>\n<li>The patient should be lying down with flexed hips and knees, keeping the knees tightly together.<\/li>\n<li>Try to pull the knees apart [Figure 55].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-168\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-55.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-55.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-55-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 55<\/span><\/span><\/p>\n<p><em>Hamstrings<\/em> (L5, S1, S2, sciatic nerve)<\/p>\n<ul>\n<li>The patient should be lying down, pulling their heels tightly against their buttocks.<\/li>\n<li>Try to extend the leg at the knee [Figure 56].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-169\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-56.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-56.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-56-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 56<\/span><\/span><\/p>\n<p><em>Anterior tibial muscle and extensor digitorum muscle<\/em> (L4, L5, S1 and peroneal nerve)<\/p>\n<ul>\n<li>Have the patient lie down keeping the leg extended, and ask them to pull their forefoot towards them as far as possible.<\/li>\n<li>Try to flex the foot (i.e., move it away from the patient) [Figure 57].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-170\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-57.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-57.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-57-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 57<\/span><\/span><\/p>\n<p><em>Gastrocnemius muscle<\/em> (L5, S1, S2, tibial nerve)<\/p>\n<ul>\n<li>Have the patient lie down keeping their leg extended, and pushing their forefoot away from them as far as possible.<\/li>\n<li>Try to extend the foot (i.e., move it towards the patient) [Figure 58].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-171\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-58.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-58.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-58-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 58<\/span><\/span><\/p>\n<p><em>Peroneal muscles<\/em><\/p>\n<ul>\n<li>Ask the patient to tilt the lateral edge of the foot upwards.<\/li>\n<li>Try to push it downwards [Figure 59].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-172\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-59.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-59.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-59-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 59<\/span><\/span><\/p>\n<p><em>Extensor hallucis longus muscle<\/em> (L4, L5, S1, peroneal nerve)<\/p>\n<ul>\n<li>Ask the patient to extend their big toe towards them as far as possible.<\/li>\n<li>Try to flex the big toe [Figure 60].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-173\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-60.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-60.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-60-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 60<\/span><\/span><\/p>\n<p><em>Flexor hallucis longus muscle<\/em> (S1, S2, tibial nerve)<\/p>\n<ul>\n<li>Have the patient flex the big toe as far as possible.<\/li>\n<li>Try to extend the toe [Figure 61].<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-174\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-61.jpg\" alt=\"\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-61.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/06\/NeuroExam_n-fig-61-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 61<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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.&nbsp; Note whether the patient\u2019s upper body leans over the stance leg (positive sign of Duchenne [Figure 51]). Note whether the patient can keep [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8],"tags":[113],"class_list":["post-175","post","type-post","status-publish","format-standard","hentry","category-motor-function","tag-the-neurological-examination"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Lower limbs - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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