[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 has had trouble walking.  Please examine their gait then discuss with the examiners your findings.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191753″][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 waddling gait caused by flexor weakness in the left hip.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Hip Flexor Weakness

To understand hip flexor weakness, it is important to understand the myotomes, whereby specific movements of muscles are supplied by specific nerve roots:

  • Hip flexion and adduction L2;
  • Knee extension L3;
  • Ankle inversion L4;
  • Ankle dorsiflexion L5;
  • Ankle plantar flexion and eversion S1.

Hip flexion is one of the most discriminatory tests of power in the lower limb (along with ankle dorsiflexion). The L2 nerve is the femoral nerve and it denervates the iliopsoas muscle.

The above list is not complete, in that other nerve roots can impact upon certain movements of muscles, but the primary nerve root is described above for the specific movements of the lower limbs. It is important to remember, that for the lumbar nerve roots, the nerves leave the spinal cord below the named vertebra. Sacral nerve roots leave the spinal cord from the foramina of the coccyx.

In addition, the nerves of the lumbar and sacral nerve roots have to travel a long distance from their origin to the muscle required, and hence a number of causes of nerve damage leads to dysfunction in the specific muscle(s).

Lower motor neurone signs (LMN) signs will include weakness, muscle atrophy and fasciculatrions. Upper motor neurone (UMN) signs will include a spastic tone and increased reflexes.

Hip weakness will be related to one of the following categories:

  • spinal cord damage (with other associated clinical signs) (UMN);
  • nerve root damage (LMN);
  • damage along the nerve (LMN);
  • nerve end-plate dysfunction (LMN);
  • muscle damage (LMN).

Hence hip flexor weakness can be due to both upper motor neurone and lower motor neurone lesions, and there may be other associated signs to help delineate these.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has left hip weakness causing a unilateral waddling gait.  I would like to begin investigating by examining the neurology in their legs.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]