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NEUROLOGICAL EXAMINATION

NEUROLOGICAL EXAMINATION. MOTOR & SENSORY FUNCTION. LOWER LIMB. AN ANATOMICAL GUIDE. 21.May.2014. Wednesday. Kaan Yücel M.D., Ph.D . TESTING THE MUSCLES. G reat extensor of the leg Femoral nerve. THIGH & POPLITEAL FOSSA. Quadriceps femoris.

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NEUROLOGICAL EXAMINATION

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  1. NEUROLOGICAL EXAMINATION MOTOR & SENSORY FUNCTION LOWER LIMB AN ANATOMICAL GUIDE 21.May.2014. Wednesday Kaan Yücel M.D., Ph.D.

  2. TESTING THE MUSCLES

  3. Greatextensor of the leg Femoralnerve THIGH & POPLITEAL FOSSA Quadricepsfemoris • Performedwiththeperson in thesupinepositionwiththekneepartlyflexed. • Personextendskneeagainstresistance.

  4. Extension@ hip joint Flexion@ knee joint Tibialnerve THIGH & POPLITEAL FOSSA Hamstringmuscles • Personflexes 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 Dorsiflexesankle& invertsfoot Deepfibularnerve Tibialisanterior • Theperson is askedtostand on theheelsordorsiflexthefootagainstresistance. • Ifnormal, itstendon can be seenandpalpated.

  6. LEG Extends great toe &dorsiflexes ankle Deepfibularnerve Extensorhallucislongus • Great toedorsiflexedagainstresistance. • Ifactingnormally, itsentiretendon can be seenandpalpated. Extensordigitorumlongus Extendsthetoes& dorsiflexesfootat theanklejoint Deepfibularnerve • Lateralfourtoesdorsiflexedagainstresistance. • Ifactingnormally, thetendons can be seenandpalpated.

  7. LEG Everts foot and weakly plantarflexes ankle Superficialfibularnerve Fibularislongusandbrevis • Thefoot is evertedstronglyagainstresistance. • Ifactingnormally, themuscletendons can be seenandpalpatedinferiortothelateralmalleolus. InitialPositionPatientplantarflexesandevertsfoot Final PositionExaminer forces the foot into inversion

  8. LEG Plantarflexesankle; raises heel during walking; flexes leg at knee joint (soleus;steadiesleg on foot) Tibialnerve Tricepssurae • Thefoot is plantarflexedagainstresistance (e.g., by “standing on thetoes,” in whichcase body weight [gravity] providesresistance). • Ifnormal, thecalcanealtendonandtricepssurae can be seenandpalpated.

  9. LEG Flexesgreattoe at alljoints; weaklyplantarflexesankle; supportsmediallongitudinalarch Tibialnerve Flexorhallucislongus • Thedistalphalanx of thegreattoe is flexedagainstresistance. • Ifnormal, thetendon can be seenandpalpated on theplantaraspect of thegreattoe as it crossesthejoints of thetoe.

  10. LEG Flexeslateralfourdigits; plantarflexesankle; supportslongitudinalarches of foot Tibialnerve Flexordigitorumlongus • 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 Plantarflexesankle; invertsfoot Tibialnerve Tibialisposterior • Thefoot is invertedagainstresistancewithfootin slightplantarflexion. • If normal, thetendon can be seenandpalpatedposteriortothemedialmalleolus .

  12. regIONS & SENSORy INNERVATION

  13. Superiorclunialnerves L1-L3 posterior rami Skin overlyingsuperiorandcentralparts of buttock Medialclunialnerves S1-S3 posterior rami Skin of medialbuttockandinterglutealcleft Inferiorclunialnerves Posteriorcutaneousnerve of thigh (S2-S3) Skin of inferiorbuttock (overlyingglutealfold Upperlateralquadrant lateralbranches of theiliohypogastric (L1) and 12th thoracicnerves (anterior rami)

  14. Obturator nerve Superior medialthigh Genitofemoral nerve Middle anteriorthigh Posteriorcutaneous nerve of the thigh Posterior aspect of thethigh 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 SuperficialfibularnerveAnterolateralleg SuralnervePosterolateralleg

  16. Mediallysaphenousnerve, whichextendsdistallytothehead of 1st metatarsal Superiorly (dorsum of foot)superficial (primarily) anddeepfibularnerves Inferiorly(sole of foot) medialandlateralplantarnerves; Commonborder of theirdistributionalongthe 4th metacarpaltoeordigit Laterallysuralnerve, includingpart of theheel. Posteriorly (heel)medialandlateralcalcanealbranches of thetibialandsuralnerves, respectively

  17. reflexes

  18. Patellar ReflexL3 & 4 A tap with a tendon hammer on the patellar ligament Calcaneal Tendon ReflexS1 & 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.

  19. NEUROLOGICAL EXAM Online resources • NeuroLogicExaminationVideosandDescriptions...an AnatomicalApproach • ThePreciseNeurologicalExam • Neuroexam • NeurologicExamination • TheNeurologicalExamination • Whatis a NeurologicalExam? • TheNeurologicalExamination • NeurologicExam

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