Introduce yourself to the patient. “Is it all right if I examine your arms/legs?” Ensure the patient is appropriately exposed, and positioned correctly (lying at 45° for the lower limb, sitting on the end of the bed for the upper limb). “Do you have any pain?”

General inspection from the end of the bed: look around for a walking stick, wheelchair, splints, orthotic devices. Look at the patient for posture, tremor.

Inspection of limbs: loss of muscle bulk, fasciculations, abnormal movements, tremor.

General Routine

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Tone, Power, Co-ordination, Reflexes, Sensation.

Tone: Normal, decreased (hypotonic) or increased (hypertonic). Cog-wheeling, lead pipe, clasp-knife, clonus.

Power: Upper limb: Shoulder abduction, adduction.

Elbow flexion, extension.

Wrist flexion, extension.

Finger abduction, adduction.

Thumb abduction.

Lower limb: Hip flexion, extension.

Knee flexion, extension.

Ankle dorsiflexion, plantar-flexion.

Ankle inversion/eversion.

Big toe dorsiflexion.

Grade 0-5 the MRC scale for muscle power.

Co-ordination: Arms out straight, eyes shut – check for psuedoathetosis with palms down and pronoator drift with palms up.

Rebound phenomenon.

Finger – nose test; varying the target.

Rapid alternating movements.

Heel-shin test.

Reflexes: Upper limb: Biceps (C5, C6); Triceps (C7); Supinator (C6).

Lower Limb: Knee (L3, L4): Ankle (S1, S2); Plantar

Sensation: Each dermatome (see diagram opposite).

Light touch.

Pin-prick.

Propcioception.

Vibration.

Gait: Normal walk.

Walk on heels. Walk on tip-toes.

Heel to toe.

Romberg’s test.

Closure: Thank the patient, ensure they are comfortable, wash hands.