Simplified system based physical examination in Paediatrics

LOWER LIMBS MOTOR EXAMINATION

1.INTRODUCE YOURSELF Palpation

-remove your watch/rings etc
-wash your hands
-Position the patient.
-adequate exposure of the lower limbs. Say “ i
would like to ideally exposed the patient from
hips downwards if patient/parents consent to it”
-elicit fasciculation on the thigh and calf muscle
by gently flicking the muscles
-If the muscle wasting is asymmetrical, confirm
by measuring
-test the tone of all group of muscles
-elicit ankle clonus

2.GENERAL INSPECTION Power

Stand back and inspect for: -ask patient if he/she could lift the legs
-alertness -abduction, Adduction, Flexion, Extension at the
-dysmorphism hips
-whether cooperative -flexion, Extension at the knees
-well or unwell -plantar flexion and Dorsiflexion at the ankles
-nutritional status-offer that you want to
measure the height and weight to plot on Reflexes
anthropometric chart -knee
-any abnormal movements e.g dystonia, -ankle
athetoid, chorea -Babinski-Use orange stick.

LOWER LIMBS -Check the spine for any scars or abnormalities.

Inspection -If you find scars suggestive of spina bifida repair,
-ask patient to walk. If he/she can’t, ask whether look for VP shunt on the scalp and feel for
he/she could stand. distended neurogenic bladder
-describe the gait if patient can walk
-then lie the patient down
-comment on the attitude of the limbs including
if there is scissoring posture/wind swept
posture/deformity
-any wasting-bilateral or one-sided wasting and
the groups involved e.g calf and quadriceps
-any apparent shortening
-look for scars especially surgical scars at ankles
-look closely for any fasciculation on the thigh
and calf muscles
In mild hemiplegic cerebral palsy, utilise other ways to elicit weakness:

The Fogg test is elicited by asking the child to walk on the heel or outside of the foot. Observe the
upper limb posturing, which correlates with the side that is weak.

Ask the child to raise his or her arms and keep them on the same level, then ask the child to close his
or her eyes. The side that is weak shows gradual pronation and falls down, this is called ‘pronator
drift’.

If the hemiplegia is obvious, doing these manoeuvres may cause the child to fall and get hurt, so do
not do them for all cases.

Assess the child’s tone by passive movements across the joints, i.e. moving the ankle through
dorsiflexion and plantarflexion passively, then doing the dorsiflexion quickly. Often this dynamic–
passive movement would lead to a ‘catch’ in