No reflex


Hypoactive (less than normal)




Hyperactive (more than normal)


Hyperactive with clonus (like a muscle spasm)

The neurocirculatory evaluation consists of the motor function, perceived sensation, and circulation appraisal. The motor portion includes assessing muscles supplied by the obturator, superior gluteal, sciatic, and femoral nerves. The function is assessed and graded on a 0 to 4/4 scale (Table 3). The sensory assessment includes evaluation of the sensory nerves originating from the L2 through S1 levels, and the sensory function should be compared (left to right) to assess uniformity. Neurologic function can be further evaluated by the deep tendon reflexes (Table 4). Reflexes at the patella (knee-jerk) test the L2-L4 spinal nerves and femoral nerve. Reflexes at the Achilles (ankle-jerk) test the L5-S1 sacral nerves. A straight leg raise is helpful in detecting radicular neurological symptoms, such as the stretching of a centrally entrapped nerve root [35].

The vascular examination includes evaluating the pulses of the dorsalis pedis and posterior tibial arteries. These should be recorded as present or absent on a 0 to 4/4 scale (Table 5). Sensation is assessed by lightly touching both sides of the patient's thigh and lower leg and asking the patient to compare these subjective findings with the other leg. A common neuralgia occurs on the anterior thigh, deriving from the anterior femoral cutaneous nerve compressed within the femoral nerve, as it passes near the psoas muscle through the pelvic brim [31,36-38]. The skin and lymphatics are also quickly inspected for swelling, scarring, or side-to-side asymmetry.

The second part of the seated examination involves examining internal and external rotational ranges of motion of the hip. The internal and external rotation measurements of the hip are recorded in the sitting position, because it provides sufficient stability and a fixed angle of 90° at the hip joint [16]. Differences may exist in the degree of internal and external rotation in extension and flexion, and assessment of these measurements is subject to substantial variability. The normal range of motion is 20° to 35° for internal rotation and

Table 5

Grading of pulses

Table 5

Grading of pulses


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