Lower Limb Neurological Examination - OSCE Guide (Old Version)

hi good afternoon hi there hi my name's stuart i'm one of the final year medical students here um can i take your name please yeah it's andrew how old are you andrew i'm 22. hi nice to meet you and what we have to do today is just doing that examination of your legs what this will involve me doing is just having to look at your legs um just test them for some power and within the muscles of your legs and testing some reflexes and some sensation is that okay with you yeah that's fine okay before i start are you any pain at all no okay so on inspection of the patient looking initially around the bed i can't see any walking sticks or walking frames or any other medical devices and it's important to note that the patient is appropriately positioned and appropriately exposed wearing shorts for this particular examination um there doesn't appear very um postural abnormalities there's symmetrical muscle bulk on either side and there's no sign of any abnormal fasciculation or any tremor okay andy um what i'd like to do first is just test the tone of your legs if that's okay what's involved me doing is just moving your legs lifting them up a little bit and just um moving your foot at the ankle okay is that okay with you that's fine yeah fine what i need to do just relax for the moment okay just like you to um move your knee outwards a little bit and lift your ankle up and just relax as much as you can what i'm going to do is just make um a few pulling motions on your ankle is that all right that's fine okay and just the same on this side please okay if you just pop your leg back down oh candy what now i like to do is just test the power in your leg um this little involved me just asking you to put your leg through a range of different movements and pushing against resistance which would be my hand is that okay yeah okay i just like you to try and lift your leg off the bed for me okay and relax and the same on this side okay and can you lift this leg off the bed for me okay if you can push down against my hand okay thanks and the same with this leg okay and push down okay can you just um bring your legs up so that your feet are flat on the bed for me please on both sides okay so if you can keep your leg here and don't let me move it the same on this side okay i'm going to do the same by just trying to push your leg towards you okay so keep it then don't let me move it okay you can just relax and put your legs flat again okay i'd just like you to try and bring your foot towards your head okay and the same on this side okay and back to this foot if you can bring your foot back towards a neutral position if you can push against my hand and the same on this side okay and finally um exactly the same thing but with your big toe okay so you can bring your toe of this foot towards you and push against my finger okay on this side okay and back towards you and the same on this side power was mrc grid five out of five in all movements of both lower limbs okay next i'd like to test is the tendon reflexes in your legs specifically the ones um at your knee and at your ankle okay what i'd like to do first is just test the one in the knee um so if you just lift your leg up and just let me take the weight completely of of your leg okay thank you and just the same on this leg okay um can i just ask you to put your leg in a similar position as we have before just being out on your ankle just like that okay and just the same on the other side if you're struggling to elicit any of the tendon reflexes because the patient is having difficulty relaxing you can use jen drastic's maneuver and what this is andy um when i try and hit your tongue on the tendon hammer what i'd like you to do is you can put your hands together like this and when i tell you if you can pull at the same time is that okay with you put your hands like that for me okay and just stay nice and relaxed and just pull okay um next i'm gonna just run a blunt plastic object just on the outside aspect of your sole on both sides in summary there was normal tone in both legs and no ankle clonus okay the next i'd like to do is just test the coordination could you take the heel of your right foot and place it on your left knee please thank you and just run it down near your left shin and again and just keep doing that a couple of times for me please that's great thank you and stop can you do exactly the same with your other leg please that's great you can stop thank you okay i'd now like to test sensation around your legs this will involve you just touching your leg in certain places starting this cotton wool what i'd like you to do is to close your eyes and just indicate when you can feel me touch please let me know whether this feels the same on both legs yeah yeah does it feel the same i said yeah yeah the sound yeah yeah yeah yeah so okay okay the next thing i want to check is a vibration sense i'm going to set the tuning fork off moving and what i'd like you to do is close your eyes tell me if you can feel it vibrating and telling when it stops okay is that okay yeah that's fine okay so if you close your eyes for me can you feel it vibrating yeah stopped you just the same on the other side all right okay next i'd like to test is your sense of proprioception what's on me doing is just holding onto your toe here and moving it towards or away from you okay i'd like you to do this part with your eyes closed and let me know um in which movement i make is that okay away from me towards me towards me away from me okay thank you i'm just going to do the same with your other foot away from me towards me towards me away from me okay thank you there was no deficit in any centering mortality of the lower limbs okay the next thing i'd like to do is just assess your gate just have a look at you walk across the room so just have to get put off the bed and if you can walk normally to that line and turn around and come back uh next thing i'd like to do is just do exactly the same again but if you can walk with one foot directly in front of the other okay is that okay yeah that's fine that's value just do the same coming back the gate was smooth and symmetrical with quick turning and the heel-to-toe test was normal well candy thank you very much indeed if you just like to get dressed there was no peripheral stigmata of neurological disease power reflexes tone and sensation were all normal and there were no geared abnormalities noted to complete this examination i'd like to do a full neurovascular examination of the lower limb you

Channel: Geeky Medics

Views: 868,450

Keywords: MRC, revision, examination, pronator, Multiple, grading, medics, Limb, Clinical, OSCE, Upper, drift, weakness, medical, Neurology (Medical Specialty), ASMR, Lower Limb, educational, Neurological Examination (Diagnostic Test), medic, medicine, Neurological, stroke, fasciculation, geeky, Exam, sclerosis

Id: Jz_sE4A0nWA

Length: 9min 50sec (590 seconds)

Published: Tue Jun 26 2012