L5 Motor Additional Tests

Name of test

Hip abduction and foot and ankle eversion and dorsiflexion

What it tests

Intact muscle and nerve innervation to the hip abductors (gluteus medius, gluteus minimus, and the tensor fascia lata) and intact muscle control of the foot and ankle; both eversion and dorsiflesion (peroneal muscles, tibialis anterior, and the extensor digitorum commuis and extensor halluics longus)

How to do it

• Have the patient lie supine with both legs together, and then test strength by having the patient spread the legs against resistance.
• This can also be done with the patient lying in the lateral decubitus position (unaffected side down), with the legs together. Ask the patient to raise the affected leg or abduct at the hip against resistance.

The normal response

5/5 strength of the foot and ankle dorsiflexors and the toe extensors

What it means if not normal

Inability to abduct the leg

• Weakness of hip abduction can produce a Trendelenburg-type gait in which the hip will adduct during the stance phase, dropping the pelvis downward.
• Weakness in hip abduction is usually seen in severe cases of l5 radiculopathy, while it is more common to see weakness in foot and ankle function with loss of dorsiflexion, foot eversion, and extension of the toes including the great toe (EHL).

Comments

Tension signs (Lasegue’s test, conventional straight leg raising test, and flip test).

Provocation of the tension signs can be elicited in the classic straight leg raising (SLR) sign by pressure in the popliteal fossa or forced dorsiflexion of the foot at the SLR starts to become painful (usually about 45 degrees).

Citations

Hoppenfeld, Stanley. Orthopaedic Neurology. Philadelphia: J.B. Lippincott Co., 1997.

K. Anderson, J. Hall. Sports Injury and Management: Philadelphia: Williams & Wilkins,1995.

Reider, Bruce. The Orthopaedic Physical Examination, 2nd Ed.: Philadelpiha: Elsevier Saunders, 2005.

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