Reflexes

Deep Tendon Reflexes

• The patient must be relaxed and positioned properly before starting.

• Reflex response depends on the force of your stimulus. Use no more force than you need to provoke a definite response.

• Reflexes can be reinforced by having the patient perform isometric contraction of other muscles (clenched teeth).

• Reflexes should be graded on a 0 to 4 "plus" scale:

• Biceps (C5, C6)

  1. The patient's arm should be partially flexed at the elbow with the palm down.

  2. Place your thumb or finger firmly on the biceps tendon.

  3. Strike your finger with the reflex hammer.

  4. You should feel the response even if you can't see it.

• Triceps (C6, C7)

  1. Support the upper arm and let the patient's forearm hang free.

  2. Strike the triceps tendon above the elbow with the broad side of the hammer.

  3. If the patient is sitting or lying down, flex the patient's arm at the elbow and hold it close to the chest.

• Brachioradialis (C5, C6)

  1. Have the patient rest the forearm on the abdomen or lap.

  2. Strike the radius about 1-2 inches above the wrist.

  3. Watch for flexion and supination of the forearm.

• Abdominal (T8, T9, T10, T11, T12)

  1. Use a blunt object such as a key or tongue blade.

  2. Stroke the abdomen lightly on each side in an inward and downward direction above (T8, T9, T10) and below the umbilicus (T10, T11, T12).

  3. Note the contraction of the abdominal muscles and deviation of the umbilicus towards the stimulus.

• Knee (L2, L3, L4)

  1. Have the patient sit or lie down with the knee flexed.

  2. Strike the patellar tendon just below the patella.

  3. Note contraction of the quadriceps and extension of the knee.

• Ankle (S1, S2)

  1. Dorsiflex the foot at the ankle.

  2. Strike the Achilles tendon.

  3. Watch and feel for plantar flexion at the ankle.

Category: Medicine Notes