🧼 Wash your hands before starting.
Introduce yourself, confirm patient’s name & DOB.
Explain: “I’d like to examine the nerves in your legs by checking muscle strength, sensation, reflexes and coordination.”
Gain consent, ensure privacy and patient comfort.

🧰 Equipment Needed

Gloves
Reflex hammer ⚡
Cotton wool/tissue (light touch)
Disposable pin/neurotip (pinprick)
128 Hz tuning fork (vibration sense)

🧠 Clinical Pearls:
– Foot drop = L4/L5 lesion or peroneal nerve palsy.
– Babinski sign = UMN lesion above S1.
– Absent ankle jerk = S1 radiculopathy.
– Stocking distribution loss = peripheral neuropathy (e.g. diabetes).

📚 Background

Level	Motor	Sensory	Reflex
L2	Hip flexion	Anterior thigh, groin	None
L3	Knee extension	Anterior/lateral thigh	Patellar (L3–4)
L4	Ankle dorsiflexion	Medial leg/foot	Patellar (L3–4)
L5	Great toe extension	Lateral leg/foot	None
S1	Ankle plantarflexion	Lateral foot/little toe	Achilles (S1–2)

🪜 Step 1: Inspection

Check both legs for symmetry, wasting, fasciculations, scars, deformity.
If possible, observe gait (limping, foot drop, steppage gait).

💪 Step 2: Motor Examination

Hip: Flexion, extension, ab/adduction against resistance.
Knee: Extension (quadriceps), flexion (hamstrings).
Ankle & Foot: Dorsiflexion (tibialis anterior), plantarflexion (gastrocnemius/soleus), inversion/eversion, great toe extension (EHL).

🖐️ Step 3: Sensory Examination

Light Touch: Cotton wool over dermatomes L1–S1.
Pinprick: Neurotip along same dermatomes.
Proprioception: Move great toe up/down with eyes closed.
Vibration: 128 Hz tuning fork on toe/ankle.

⚡ Step 4: Reflexes

Patellar Reflex: (L3–L4).
Achilles Reflex: (S1–S2).
Plantar Response: Flexor = normal. Extensor (Babinski) = UMN lesion.

🌀 Step 5: Coordination & Gait

Heel-to-Shin: Smooth, accurate movement = intact cerebellar function.
Gait: Observe stride, balance, foot clearance. Look for ataxic, spastic, or high-steppage gait.

✅ Step 6: Closure

Thank patient, redress, ensure comfort.
Summarise: “On examination there was weakness of ankle dorsiflexion and reduced sensation over L5 distribution, suggestive of possible radiculopathy.”
Wash hands and document thoroughly.

⭐ Key OSCE Points

Systematic approach: Inspection → Motor → Sensory → Reflexes → Coordination.
Always compare left vs right.
Explain steps clearly to keep patient at ease.
Relate findings back to spinal levels.

🚫 Common Pitfalls

Skipping inspection/gait (often gives the first clue).
Not comparing both sides → miss subtle asymmetry.
Rushing reflexes → can miss hyporeflexia.
Not correlating UMN/LMN signs with possible lesion site.

📚 References

Clinical Examination – Talley & O’Connor
Geeky Medics OSCE Guide
OSCEstop – Online practice stations

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

OSCE Lower Limb Neurological Examination

👋 Introduction