Bragard sign tests for sciatic radiculopathy due to nerve root irritation from a lumbar disc herniation. When you straighten the leg to provoke pain and then dorsiflex the ankle, if the pain is amplified or reproduced, it points to nerve root irritation rather than purely musculoskeletal tightness. The dorsiflexion stretches the sciatic nerve and its roots, revealing radicular pain that travels down the leg in a dermatomal pattern. This makes the sign helpful for distinguishing radicular nerve involvement from conditions that cause local back or buttock pain, such as facet joint irritation or sacroiliac dysfunction, which do not typically produce the same reproducible leg radiation with nerve tension maneuvers.

A normal skull palpation shows a smooth, symmetrical contour without tenderness or swelling. As you gently feel from the forehead back to the occipital region, the bone surface should be uniform and free of lumps, depressions, or irregularities. Tenderness would raise concern for inflammation, infection, or fracture, and swelling or noticeable irregularities suggest trauma or underlying pathology. In adults, indentations or noticeable asymmetry are not expected, so describing the skull as smooth and symmetrical captures the normal finding.

Testing the hypoglossal nerve focuses on the tongue’s motor function. Since this nerve controls the tongue muscles, you assess how the tongue moves and what signs appear on the tongue itself. When the patient sticks out the tongue, a normal tongue stays midline. If there’s weakness on one side, the tongue deviates toward the weaker side. You also look for fasciculations (twitches) and atrophy (wasting) of the tongue muscles, which signal denervation from a hypoglossal nerve issue. These signs—fasciculations, atrophy, and deviation—together reflect CN XII function. The gag reflex and tongue sensation involve other cranial nerves (glossopharyngeal/vagus and trigeminal), hearing and balance involve the vestibulocochlear nerve, and visual fields involve the optic nerve, so they aren’t part of CN XII testing.

Palpation here is about locating the pes anserine region on the medial knee, where three tendons converge. The pes anserinus is the insertion point on the medial proximal tibia for the gracilis, sartorius, and semitendinosus muscles. You feel this area on the medial side just below the knee joint line, where these tendons attach to the tibia (roughly a couple of centimeters below the joint line). This location is distinct from other nearby structures: the medial collateral ligament runs higher up along the inner knee, the popliteal fossa is behind the knee, and the medial meniscus lies inside the joint space. Therefore, the described area corresponds to the pes anserine region because that is exactly where those three tendons insert and where tenderness or bursa irritation is assessed.