[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient presented following numerous falls.  Please examine their gait and discuss with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191751″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has a bilateral footdrop.  The clinical signs exhibited in this video include a bilateral steppage gait.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Common peroneal nerve palsy

This is also commonly known as foot drop, but it is not the only cause. The physical signs include wasted lateral leg muscles (if chronic) and ankle dorsiflexion and eversion weakness. Some textbooks also report a sensory impairment over the lateral calf and dorsum of the foot, but this is inconsistent in the literature and unclear if of clinical significance. If there is any weakness of ankle inversion then this indicates that the lesion is higher than the common peroneal nerve.

Be sure to not miss the gait correcting callipers which may be somewhere around the bedside. A common error among candidates is to not take mental note or then convey to the examiners what has been seen around the bed side. As a result, candidates often miss vital clues that would help determine the diagnosis!

Other clinical signs include an intact ankle reflex. The common peroneal nerve and the tibial nerve are the two branches of the sciatic nerve, and as the latter converts the ankle refle, in a common peroneal nerve palsy it is spared. This helps differentiate peroneal nerve palsy from conditions that lead to an absent ankle reflex (S1 radiculopathy, complete sciatic nerve lesion or a rare tibial nerve lesion).

Other causes of foot drop include: a partial sciatic nerve lesion; radiculopathies of L4 or L5 or HSMN.

The most common cause of common peroneal nerve damage is trauma to the neck of the fibula, plaster casts, or, especially in women, frequent and prolonged leg crossing. In addition systemic disease, such as diabetes mellitus and vasculitides which cause widespread nerve damage as well as leprosy may lead to this clinical sign.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has a bilateral foot drop.  I could not detect any upper motor neuron signs.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]