II. Exam: Complete Neurologic Evaluation

  1. Motor Exam
    1. Knee extension (L4)
    2. Foot inversion (L4)
    3. Foot dorsiflexion (L5)
    4. Great toe extension (L5)
    5. Foot Plantar Flexion (S1)
    6. Foot Eversion (S1)
  2. Sensory Exam
    1. Knee and medial leg (L4)
    2. Foot dorsum and great toe (L5)
    3. Lateral foot and plantar foot (S1)
  3. Deep Tendon Reflexes
    1. Hyperactive reflexes with abnormal Babinski
      1. Suggests Bilateral pyramidal tract dysfunction
      2. Spinal cord compression
      3. Cervical Spondylosis
      4. Tumor
      5. Central DIsc Herniation
    2. Hypoactive reflexes
      1. Bilateral
        1. Normal
        2. Spinal Shock
        3. Myopathy
      2. Unilateral: Peripheral Nerve
        1. Ankle (S1)
        2. Knee (L3,L4)

III. Exam: Measure thighs and calves (signs of muscle atrophy)

  1. Significant Discrepancy
    1. Thigh difference: >1/2 inch
    2. Calf difference: >1/4 inch

IV. Exam: Sitting root test (Sitting Straight Leg Raise)

  1. Observe discrepancy between supine and sitting SLR
    1. Discrepancy suggests Malingering
  2. Not as sensitive as standard supine SLR

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