Lower Limb Neurological Examination - OSCE guide (old version) | UKMLA | CPSA

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This video demonstrates how to perform a lower limb neurological examination in an OSCE station, including assessment of gait, tone, power, reflexes and coordination.
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Chapters:
- Introduction 00:00
- General inspection 00:33
- Gait 00:52
- Romberg’s test 01:36
- Tone 01:49
- Power 02:21
- Reflexes 04:09
- Fine touch and pin-prick sensation 05:12
- Vibration sensation 06:22
- Proprioception 07:03
- Co-ordination 07:38
- Summary of findings 08:37
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Always adhere to your medical school/local hospital guidelines when performing examinations or clinical procedures. DO NOT perform any examination or procedure on patients based purely upon the content of these videos. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video.
Some people have found this video useful for ASMR purposes.
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[@kartace1]

Testing sensation is often misunderstood: 1. Crude (pressure) touch - carried in both dorsal column-medial lemniscus (DCML) AND the Spinothalamic tract (STT) 2. Fine touch/vibration/proprioception - carried in the DCML only 3. Pain/temperature - carried in the STT only - So when you're testing sensation you want to be able to discriminate between these two pathways (DCML/STT), because they're different anatomical areas of the spinal cord, so different injuries produce different clinical signs. - This means that when you're testing sharp/blunt discrimination. You need to ask the patient to tell you whether the sensation is 'sharp or blunt', because this tells you if their STT is working. If they simply say 'yes i can feel that' then you don't know if they percieved a sharp sensation or a blunt sensation and all you know is that their crude sensation is intact so that means either the DCML OR the STT are working, but one or the other may still be broken. - Equally, when you're testing fine touch sensation, it really does need to be fine touch rather than pressure, or you won't be isolating the DCML and you may be getting some crude touch (pressure) sensation crossover from the STT. - Finally the reason we test proprioception/vibration and temperature is because in neurological injury/disease these sensations are generally lost before pain/fine touch/crude touch, and so it makes our examination more sensitive to the earlier stages of peripheral neuropathy, for example.

[@Gingerjuli]

Thanks for explaining this. Very interesting

[@mmmmm824]

Tahnk you very ,uchhh

[@tutoringwithbecky695]

Thanks for all the great videos! By the way, a neurologist told me that when testing tone with leg lift, the aim is not to drop the leg and see it bounce, it's to look at the heel as you lift the leg. If the heel leaves the bed, the leg is hypertonic, if it slides up the bed then the leg has normal or reduced tone. You can then place the leg down rather than dropping it. It's nicer to the patient, if anything!

[@sabakindi2736]

What you are saying is correct, I read it at Macleod’s clinical examination book.

[@fadeskywards1245]

I was wondering how to do this. Thanks for your comment!

[@evegroult5184]

We do the drag test so relaxed leg wiggle it a wee bit and then elevate knee to see if it lifts or just comes towards your tailbone. :) I was thinking the same as hadn’t seen the drop test :)

[@mircygirls4]

7:50 the way he keeps looking at him😭

[@lbcreativedesigns9210]

Yeah and it's not just in this video 🤷

[@tfoprincess]

If the doctor asked me to walk normally, I'd trip from awkwardness.

[@JFZ931]

7:52 that awkward look lol!!

[@PalpatineAtMach11]

That smile at 5:09 had me crying 😂😂😂

[@iroowu]

Thank you all for preparing everybody's examination effectively!!

[@user-om3dg3ym9x]

thanks for getting me through 5 years of medical school!

[@ramilchow620]

Med student from Sydney. Love these videos. U guys are legends!!

[@elizclark4912]

Very thorough assessment. The patient is so fit.

[@DrAdilRamzan]

thank you. tomorrow is my long case .. so watching your videos. i noticed you did the heel to shin test differently. . . ! anyways nice job. thankyou.

[@phantasm1004]

A very thorough neurological examination of the lower extremities. Thank you!

[@joaoeduardo7555]

Med Student from Brazil. You guys are awesome, keep it up!!!

[@preloshmoodley5438]

In the midst of my medical board exam part 2, these videos are a God send. Thank you.

[@amulyapremkumar2349]

i love these videos! I hope to be that tension free in examining, one day. p.s. The patient kept looking at the doctor with an expression that seemed like, "I wish to show my best, i wish the doctor feels proud of my abilities!" Also, how i wish all patients had such a cute smile and all doctors did their examination so effortlessly. regards, a medical student in the making.

[@melreyes7237]

The eye contact tho. 😍😍😍😍😍

[@DrArobinson]

Great videos guys. As for the proximal muscle weakness it needs to be from a lower starting height to truly assess.

[@geekymedics]

+DrArobinson Yes we'd agree with this. Ideally you'd ask the patient to stand from a chair. Great feedback.

[@lickerwishstick9217]

This is one of my favorite youtubes.

[@rudrikthakkar2985]

Great video. Of huge help, thank you!

[@_gabrielcosta.]

Great video guys!! Helped me a lot!

[@BibekTimilsina007]

@Geeky Medics As a Suggestion only, while eliciting the plantar reflex one shouldn't keep running the blunt end till the end; what I read was to stop after you get the reflex!!!

[@VinnithPullavarayar]

In checking tone with leg roll your eyes should be fixed on the movement of the foot. You have to roll slowly and increase the speed. Normal: foot follows rotation of leg under slow motion, unable to follow ( lags ) in fast motion LMN lesion: foot not able to follow leg rotation in both slow and fast motion. UMN lesion: foot able to follow leg rotation in both slow & fast motion. Leg drop: Normal: Leg drops quickly + at same spot LMN lesion: Leg drops quickly + sideways ( different spot ) UMN lesion: Leg drops slowly + same spot.

[@Dhminyou]

David..You are boss..Keep it up

[@fadi1970able]

It is simple and clear. Many thanks

[@zywoomeister3654]

View outside the window looks like a wallpaper, until we see the cars passing by.. Amazing video & view. Thank you!

[@axmed1556]

My reference of physical examination. Thank you guys.

[@MrFASSOLY1990]

Great job guys 👍 Thank you

[@Islandertravels_]

good job, but how about the soft and sharp test? why you dont do it together to assess both tracts?

[@rumit9946]

love the bird sounds in the background

[@humansofmedicine]

By far the best peripheral neuro exam.

[@zainabalkurdi6175]

So helpful big thanks🙏🏻

[@LF-tt4ci]

keep it up guys this is so much helpful thank you

[@FrankieG-M]

Got my finals tomorrow. My whole day will be rewatching all these videos 😂

[@kurbonbiabduloeva5007]

Awesome channel. Thanks

[@sanamlily240]

thank u and really amazing videos :)

[@HaifaAlshammari]

Thank you , it helped me a lot 💕

[@salah-eddinebarrajjal308]

Hello, I'm a patient at a neurologist. May I ask you some questions about my current state, please?

[@anastasiaaa4094]

exellent. Thank you for your help

[@fadi1970able]

Excellant. Thank you

[@madamhenry]

Great video. Although do you feel that testing plantar flexion against your hand would be sufficient to establish myotomal weakness? These muscles lift the entire body against gravity after all so should easily overcome your hands even if weak. I feel the tip toe walk at the beginning would better highlight any weakness in L4.

[@madamhenry]

*S1 I meant! :)

[@fiona9671]

Examinations may need to be altered within parameters of patient ability. Many patients within healthcare would not be able to tiptoe, so think showing both as a medical student is important.

[@nhmsoikat]

it's a great video and I enjoyed learning so much😁😁

[@drlakhanajmeria1272]

So dank! You inspire me everyday!!!

[@abdulrafaysoomro]

Best ever video seen for lower limb neurologic exam.

[@Mohammadasif-ve7vm]

excellent video

[@anastasiaaa4094]

Thanks from maldives

[@DrDinooshDeLivera]

Thank you!

[@rowahmad1189]

very useful thaaaanks alot

[@anisharaj7736]

Thanks a lot sir.plzz make more n more videos

[@bloomingflower3708]

Excellent. Thanks a lot...

[@TheSideProject]

BRAVISSIMO! 👏🏻

[@Wierzej1]

2:50 Dr David's peripheral CRT is more than 2 sec. - septic shock? 😁

[@jimstoesz3878]

I hope to one day have the kind of chemistry that Dave and Harry have with someone.

[@ahmedalbasri7280]

Thank you so much

[@user-jd5ni8mh5o]

Harry can't keep his smile 😂😂

[@a.fatahbm140]

Really appreciate for ur effort guys. 🙏

[@locolovatic]

thank you very much

[@Saravostoo888]

Actual inspiration

[@Cuttea7]

you are so awesome 😚❤️👌

[@oumamaderkaoui6130]

thank you

[@farhadahmad5840]

What about sensory exam? Distal to proximal? Or the way you did..

[@hidayatullah6353]

Really good

[@sohaila9068]

i will be hearing everyone out

[@manisharani5683]

Very nice sir ,

[@h.a7688]

thanks very much....oh GOD I wish one day I will be able to do examination like you guys ...I freak out in every exam and my body not respond, blanking and totally embarrassed

[@geekymedics]

Things get easier with practice and remember that these videos aren’t done in one take! So don’t put too much pressure on yourself. Good luck with your future exams 🤞

[@HassamAlizai]

Ah same. I hope it gets easier

[@abdushummakhi8936]

Greet job

[@nahlasalih4443]

Thank alot

[@biotamil5663]

Thankyou

[@sthakur66901]

thanks

[@DarkWarrior012]

badman helping bruddas like me out when its finals round da corner, stay BREDA -1-

[@FatimaHDaham]

the examiner remind me of that guy from baby driver you know Thee baby driver I forgot his name

[@Accio-ci3go]

Ansel Elgort. I think he looks like him too

[@zerin.]

Thank u

[@geekymedics]

Learn clinical skills on the move and support us in producing more awesome videos with the Geeky Medics app geekymedics.com/geeky-medics-app/ 👾💉🎉

[@brightlight9921]

Great

[@drspine5291]

Well good effort

[@asdfghjkl750420]

Excellent ^_^

[@ishanidarshika5029]

great

[@hadula31]

good

[@Aman0332]

Tnx

[@jawadshirzad4644]

Good 👍👌👌

[@JM-rp3lx]

HIP FLEXION should be performed with the hip joint flexed to 90° so as to eliminate activity of the rectus femoris. Hip Extension was also poorly tested, it should be tested in prone (in supine the quadriceps were used to push down the examiners hand).

[@MrJackBroady]

well thats one way to break your tuning fork

[@h.a7688]

Thanks ❤️❤️❤️ wish me luck & pray for me so i can pass the exam.. I am so worried

[@drfuadsaid8529]

Thank you

[@zzzzzzX.7]

Why does this guy always look like he’s about to burst out laughing?😅

[@geekymedics]

Supercharge your clinical skills with our collection of OSCE Stations, Questions and Flashcards 👾 geekymedics.com/bundles

[@smilyyyflower175]

why we use a cotton tip then a metal pin , isnt it the same?

[@user-oz3tf1ev9e]

One is testing for light touch (dorsal column) and one is pain (spinothalamic tract). Please correct me if I am wrong.

[@damilolaoladunni6346]

Spinothalamic tract tests for light touch (anterior)& pain and temperature (posterior spinothalamic) while posterior column tests for proprioception,vibratory sense,2 point discrimination

[@imedscience2771]

Is the doc Michael Cera from Superbad? 🤷‍♀️🤣💗💕

[@geekymedics]

Watch our NEW and UPDATED version of this video here: kzbin.info/www/bejne/f5XQgoaMj7Nja6s 🚨

[@iancampbell6356]

Awesome video! Awareness of joint movement direction is kinesthesia, not proprioception (which you assessed with the Romberg)

[@jesseleemata4107]

www.sciencedirect.com/science/article/pii/S2095254615000058 The original definition of proprioception, given by Charles Sherrington when he first used the term, was that proprioception is “… the perception of joint and body movement as well as position of the body, or body segments, in space”, and the “perceptions of the relative flexions and extensions of our limbs”.9 Here Sherrington refers to proprioception as “perception” of body position and movement.

[@iancampbell6356]

Jesselee Mata Hello, This exert from the article you referenced summarizes my comment nicely, "a recent systematic review by Witchalls et al.41 has demonstrated that proprioception as a measure of the neuromuscular response to a stimulus must involve sensory input, central processing, and motor output in a closed loop. In light of this latter view, it is insufficient to consider proprioception just as a cumulative neural input to the central nervous system (CNS) from the mechanoreceptors located in muscles, joints and the skin,42, 43, 44 and 45 and it is inappropriate to interpret either passive movement detection without muscle activation or a measure of reflex muscle activation46 as overall proprioceptive ability." Especially that last sentence. Since passive movement should not be included in the overall assessment of joint proprioception, we consider detection of passive movement to be termed kinesthesia. Thank you for your article reference!

[@iancampbell6356]

Jesselee Mata Though, I should mention that both the open and closed loop systems involved with either passive or active movement of peripheral joints can be referred to as proprioception. My comment concerning kinesthesia detection via passive movement (which is really proprioceptive testing and now we're just splitting hairs) was in regard to the clinical nature of the video. If I perform two proprio tests on a patient, an active and passive (hallux positioning vs. setting with the UEs), I need a way to differentiate those tests in my documentation, thus the reason for me referring to the passive test as kinestheisa (which is still really just proprioception, and highlights the fact we don't really fully understand the neural workings of joint position sense in the human body).

[@Legendkilla05]

You can't tell me when my toe is up or down! Lol I know which way is up and down! 😆

[@drosaama]

What is he checking at 08:18 ??

[@Legendkilla05]

Way he said put your socks & shoes back on was funny! As if he had stinky feet 😆 it sounded more like a command especially with the head nod! Usually they say u can now put your socks & shoes on just a little tiny detail! Lol Edited: Oops I put the volume up louder on my head set he does actually say you can put your socks and shoes back on! Oh well I'll still leave my comment it was funny!

[@amanuelmatewos]

Better if you edit the video with pathological content just to compare. Nice tho!

[@h.a7688]

SWIFT..0:42

[@user-il1zi7go7k]

❤❤❤

[@abedan1258]

😍😍😍

[@drspine5291]

All the persons selected for examination are normal ones its better idea to have patients with combined deficits to have genuine look

[@icarus6492]

dr ortho this is a basic examination for teaching purpose. before we learn what is abnormal,it is important to know what is normal. but i agree, it's nice if they can demonstrate how some abnormal ones appear.

[@NoZeroful]

dr ortho it is not allowed to use patients (even if they give consent) for public educational videos

[@7al00m]

most osce stations are normal findings

[@kryztofsharpe8566]

I wish XD

[@amardevaguru3184]

👌🏻👌🏻

[@drdj69]

if you are studying for AMC you only get 8 minutes per case. no way u can cover all this in examination. LOL

[@laa2009]

We get 6.5 minutes, you definitely can do all of it. In clinical practice you would take as long as you need, something I have always disliked about OSCE's... trained to rush!

[@itssomeone4407]

🙂👏👏👏👏👏👏👏👏👏👏👏

[@DrNephro]

Good job....but the rythm of the video is slow...becouse in the exam u have just 7 mins to finish

[@Rosie-bz1gz]

Why use someone fit and well

[@fadeskywards1245]

The point of the video was the process rather than the results and it was likely that the patients wouldn't be happy with being filmed.