QUARTERLY BEAT / JULY 2025
HANDS ON EVALUATION OF THE LIMBS I normally start with the pelvic limbs and move to the thoracic limbs – do what works best for you. I like to start in the back because I start with evaluating for good femoral pulses, especially if they are presenting for intermittent pelvic limb weakness. When evaluating the limbs you are trying to decide if you have an upper motor neuron or a lower motor neuron limb. To figure this out, you are focusing on evaluation of conscious proprioception/CP’s and the NEURO RAT > R = REFLEXES A = ATROPHY T = TONE Remember, you have already assessed evidence of paresis or plegia during the gait evaluation, so you already have that information. Below is a chart of what you should be minimally assessing with the limbs.
Spinal Hyperesthesia: Save this for last and only assess if it isn’t obvious where the patient is painful. There are many patients that come in and you can clearly see where they hurt, in those cases spinal palpation is not performed. If I am not certain, then I will evaluate for spinal hyperesthesia with gentle spinal palpation. Again, never perform range of motion of the cervical spine. Pain Sensation: This is also a component of the neurologic examination that should be saved for last and only should be performed in plegic animals. I cannot stress this enough – you should only be assessing for pain sensation in a limb if the animal is plegic. If the animal is ambulatory, don’t do it. If the animal is non-ambulatory paraparetic (i.e., you can see good movement of the pelvic limbs but the patient isn’t strong enough to ambulate alone), don’t do it. There is no reason to evaluate a patient for pain sensation in a limb if there is movement of the limb. If they can move the limb, they can feel it. The one exception to this rule is the patient that is chewing their foot off due to a sensory neuropathy – but this is rare. When you are assessing pain sensation you need to be sure that the patient consciously acknowledges that you are pinching their toes. A conscious response means either the patient vocalizes, turns their head or tries to bite you. A withdrawal of the limb is just a reflex and does not indicate pain sensation. Most paraplegic, deep pain negative dogs that come in will have intact withdrawal reflexes, so don’t let it fool you. There must be a conscious acknowledgement, not just pulling back of the limb. If after all your hard work, you still can’t fit your patient into one of the nice neurolocalization regions in the chart above, don’t worry! It is likely, because your patient is multifocal and therefore, they shouldn’t fit nicely into one of the boxes above. A multifocal neurolocalization is a neurolocalization region! END RESULT Now, your patient is successfully neurolocalized and you can open any neurology textbook to start making your list of differentials to make your best recommendations for diagnostics and treatment options.
Withdrawl Reflex
Patellar Reflex
CP's
Atrophy
Tone
Hyper- Reflexive, Normal, Decreased/ Absent Hyper- Reflexive, Normal, Decreased/ Absent
Normal, Mild Atrophy, Pronounced Atrophy Normal, Mild Atrophy, Pronounced Atrophy
Increased, Normal, Decreased, Absent Increased, Normal, Decreased, Absent
Intact/ Delayed/ Absent
Thoracic Limbs
Hyper- Reflexive, Normal, Decreased/ Absent
Intact/ Delayed/ Absent
Pelvic Limbs
Once you evaluate the above for each limb, you then can identify each limb as either: UPPER MOTOR NEURON = Normal to increased segmental reflexes, mild atrophy, normal to increased tone.
VS
LOWER MOTOR NEURON = Decreased to absent segmental reflexes, moderate to severe atrophy, decreased to absent tone. Based on all of the above information that you have gathered, you can then neurolocalize your patient more confidently to one of the following areas.
Lower Motor Neuron
BRAIN C1-C5 C6-T2 T3-L3 L4-S3
Thoracic Limbs
LMN
LMN
UMN UMN
Normal
Normal
Pelvic Limbs
LMN LMN
UMN UMN UMN UMN
Still not convinced of your neurolocalization? Good news, there are a few more steps you can take to continue to narrow it down!
Tail Tone and Movement: Can be abnormal (decreased) with L4-S3 lesions.
Anal Tone: Can be abnormal with L4-S3 lesions.
Cutaneous Trunci Reflex: This reflex is normally present between T2 through L4/5 and can be most helpful with C6-T2 and T3-L3 myelopathies. It can be lost just caudal to a lesion anywhere along the T2 through L4/5 path. Start testing caudally and work your way forward, once you get the reflex there is no reason to continue evaluating it cranially.
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