Paediatric Lower Limb:
General inspection:
-
Temperature / BP / HR / RR / CRT
General activity and appearance, growth, muscle bulk, symmetry, syndromic appearance
Activity:
o Walking into room
o Mobility
o Hypertonia / hypotonia / spasticity / limp / etc
Examine
Special tests: Build rapport. Aka Department of Funny Walks
- Walking, jumping, running
- Standing and walking on toes and on heels
- Reaching up, squatting
- Trendelenburg test (hip muscle bulk)
- Romburg (proprioception)
Focused limb exam:
- General muscle bulk, scars, deformities, leg lengths
- Fasciculations, atrophy, tremors, non-purposeful movements
Tone:
-
At knee and ankle. Distract and move
o Hypertonia, hypotonia
Power:
- At all joints. Isolate by having one hand above and below the joint in question.
o Grade 1-5
o Hip / knee / ankle
Reflexes
- Knee jerk (L2, L3, L4 nerve roots)
- Ankle jerk (S1 and S2 nerve roots)
Coordination:
- Toe to finger, heel down the slide (tibia)
- Tapping foot inferiorly onto hand
Sensation:
- All dermatomal areas, and assess for length-dependent neuropathy as well.
- Proprioceptive sensation – toe movement.
If time: ROM and assessment of irritable joints:
- Hip: abduct / adduct / internal / external rotation / FABER test / grind
- Knee: test ACL / PCL / MCL / LCL, grind test
- Ankle: internal and external rotation