1. NEUROLOGICAL EXAMINATION MOTOR & SENSORY FUNCTION
LOWER LIMB
AN ANATOMICAL GUIDE
Kaan Yücel M.D., Ph.D.
21.May Wednesday

2. TESTING THE MUSCLES

3. THIGH & POPLITEAL FOSSA
Great extensor of the leg
Femoral nerve
Quadriceps femoris
Performed with the person in the supine position with the knee partly flexed.
Person extends knee against resistance.

4. THIGH & POPLITEAL FOSSA
hip joint
knee joint
Tibial nerve
Hamstring muscles
Person flexes his leg against resistance.
Normally, these muscles—especially their tendons on each side of the popliteal fossa—should be prominent as they bend the knee.

5. LEG Tibialis anterior Dorsiflexes ankle & inverts foot
Deep fibular nerve
Tibialis anterior
The person is asked to stand on the heels or dorsiflex the foot against resistance.
If normal, its tendon can be seen and palpated.

6. Extensor hallucis longus
LEG
Extends great toe & dorsiflexes ankle
Deep fibular nerve
Extensor hallucis longus
Great toe dorsiflexed against resistance.
If acting normally, its entire tendon can be seen and palpated.
Extensor digitorum longus
Extends the toes & dorsiflexes foot at the ankle joint
Deep fibular nerve
Lateral four toes dorsiflexed against resistance.
If acting normally, the tendons can be seen and palpated.

7. Fibularis longus and brevis
LEG
Everts foot and weakly plantarflexes ankle
Superficial fibular nerve
Fibularis longus and brevis
The foot is everted strongly against resistance.
If acting normally, the muscle tendons can be seen and palpated inferior to the lateral malleolus.
Initial Position Patient plantar flexes and everts foot
Final Position Examiner forces the foot into inversion

8. LEG
Plantarflexes ankle; raises heel during walking; flexes leg at knee joint (soleus; steadies leg on foot)
Tibial nerve
Triceps surae
The foot is plantarflexed against resistance (e.g., by “standing on the toes,” in which case body weight [gravity] provides resistance).
If normal, the calcaneal tendon and triceps surae can be seen and palpated.

9. Flexor hallucis longus
LEG
Flexes great toe at all joints; weakly plantarflexes ankle; supports medial longitudinal arch
Tibial nerve
Flexor hallucis longus
The distal phalanx of the great toe is flexed against resistance.
If normal, the tendon can be seen and palpated on the plantar aspect of the great toe as it crosses the joints of the toe.

10. Flexor digitorum longus
LEG
Flexes lateral four digits; plantarflexes ankle; supports longitudinal arches of foot
Tibial nerve
Flexor digitorum longus
The distal phalanges of the lateral four toes are flexed against resistance.
If they are acting normally, the tendons of the toes can be seen and palpated.

11. LEG Tibialis posterior Plantarflexes ankle; inverts foot Tibial nerve
The foot is inverted against resistance with foot in slight plantarflexion.
If normal, the tendon can be seen and palpated posterior to the medial malleolus .

12. regIONS
&
SENSORy INNERVATION

13. Upper lateral quadrant
Superior clunial nerves
L1-L3 posterior rami
Skin overlying superior and central parts of buttock
Medial clunial nerves
S1-S3 posterior rami
Skin of medial buttock and intergluteal cleft
Inferior clunial nerves
Posterior cutaneous nerve of thigh (S2-S3)
Skin of inferior buttock (overlying gluteal fold
Upper lateral quadrant
lateral branches of the iliohypogastric (L1) and 12th thoracic nerves (anterior rami)

14. Obturator nerve
Superior medial thigh
Genitofemoral nerve
Middle anterior thigh
Posterior cutaneous nerve of the thigh
Posterior aspect of the thigh
Intermediate cutaneous nerve of the thigh (femoral nerve)
Variable area on the medial aspect of the thigh
Medial cutaneous nerve of the thigh
(femoral nerve)
Medial aspect of the thigh

15. Saphenous nerve (femoral nerve)
Medial aspect of leg
Posterior cutaneous nerve of the thigh
Upper part of the leg
Superficial fibular nerve Anterolateral leg
Sural nerve Posterolateral leg

16. Medially saphenous nerve, which extends distally to the head of 1st metatarsal
Superiorly (dorsum of foot) superficial (primarily) and deep fibular nerves
Inferiorly (sole of foot) medial and lateral plantar nerves; Common border of their distribution along the 4th metacarpal toe or digit
Laterally sural nerve, including part of the heel.
Posteriorly (heel) medial and lateral calcaneal branches of the tibial and sural nerves, respectively

17. reflexes

18. Calcaneal Tendon Reflex S1 & 2
Patellar Reflex L3 & 4
A tap with a tendon hammer on the patellar ligament
Calcaneal Tendon Reflex S1 & 2
Person's legs are dangling over the side of the examining table. The calcaneal tendon is struck briskly with a reflex hammer just proximal to the calcaneus. The normal result is plantarflexion of the ankle joint.

20. NEUROLOGICAL EXAM Online resources
NeuroLogic Examination Videos and Descriptions...an Anatomical Approach
The Precise Neurological Exam
Neuroexam
Neurologic Examination
The Neurological Examination
What is a Neurological Exam?
Neurologic Exam