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3-C
August 11, 2014
PLM CM
REFLEX TESTING
Dr. Guzman
Legend: normal text lecture/old trans; Bates italics; transers
notes red text.
Cervical 5,6
Cervical 6,7
o JENDRASSIK
MANEUVER: In leg
reflexes: ask to lock
fingers and pull one
hand against the other.
Tell patient to pull just
before you strike the
tendon.
1.
2.
3.
4.
5.
Normal response:
Contraction)
Plantar
Flexion
(Gastrocnemius
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2.3-C
August 11, 2014
PLM CM
REFLEX TESTING
Dr. Guzman
1. Position:
Seated,
lower arm resting on
pts lap
2. Tendon cant be seen
or well palpated. It
crossed the radius
approx.
10cm
proximal to the wrist.
3. Strike.
Normal response: Elbow flexion and supination of forearm
(palm upward)
Pts hand should rest on abdomen or lap, w/ forearm partly
pronated -> strike radius with point or flat edge of reflex
hammer, about 1 to 2 inches above the wrist.
4.
1.
2.
3.
Two
possible
positions: form a
right angle at the
shoulder. Lower arm
should be dangling
directly
downward.
OR. Have pt place
hands on hips
Triceps
tendon
extends across elbow to the back of the upper arm
If arms are on hips: arm will not move, but muscle
should shorten vigorously
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2.3-C
August 11, 2014
PLM CM
REFLEX TESTING
Dr. Guzman
Complete
resection of
UMN
Reflex
Pectoralis
reflex
OTHER DTRs
Segment
How to Elicit
C5-T1
Pronator
reflex
C6-C7
Upper
abdominal
muscle
reflex
T8-T9
Midabdominal
muscle
reflex
Lower
abdominal
muscle
reflex
Adductor
reflex
T9-T10
Hamstring
reflex
T11-T12
L2-L4
L4-S2
Have pt elevate
arm place
fingers of your left
hand upon pts
shoulders with
your thumb
extended
downwards
strike your thumb
directly slightly
upward toward
pts axilla
Grasp pts hand
hold it
vertically so the
wrist is
suspended from
the medial side
strike distal end of
radius directly
with horizontal
blow
Tap muscles
directly near their
insertions on the
costal margins
and xiphoid
process
Tapping an
overlaid finger
Tap muscle
insertion directly
near symphysis
pubis
Supine, lower
limbs slightly
abducted Tap
directly the
Adductor magnus
just proximal to its
insertion on the
medial epicondyle
of the femur
Supine, hips and
knees flexed at
90, thigh rotated
slightly outward
Place left hand
under popliteal
fossa to
compress medial
hamstring
Normal
Response
Muscle
contraction
seen or felt
Pronation
of forearm
Contraction
Contraction
Thigh
adduction
Knee
flexion,
contraction
of medial
mass of
hamstring
Primary
results to loss of reflexes, disease at
disease of
target organ/muscle precludes movement
NMJ or the
muscle itself
Systemic
direct toxicity to a specific limb of the
disease
system
states
poorly controlled diabetes peripheral
sensory neuropathy
extremes of thyroid disorder also affects
reflexes (mechanism unknown)
Hyperthyroidism
hyperreflexia
Hypothyroidism hyporeflexia
Detection of an abnormal reflex (hyper/hypo/arreflexia)
does not necessarily tell which limb of the system is
broken or what might be causing the dysfunction.
Impaired sensory input or abnormal motor nerve
function decreased reflexes
Only by considering all of the findings, together with the
rate of progression, pattern of distribution (unilateral,
bilateral, etc.) and other medical conditions can the
clinician make educated diagnostic inferences about the
results generated during reflex testing
TROUBLESHOOTING
If unable to elicit reflex: consider the following:
o Are you striking the correct place? confirm by
observing and palpating the appropriate region while
asking pt to perform an activity that causes the
muscle to shorten to make the tendon more apparent
o Make sure that the hammer strike is falling
directly on the appropriate tendon if plenty of
surrounding soft tissue (dampens force of strike),
place a finger firmly on the tendon and use that as
target
o Make sure that the muscle is uncovered so that
you can see any contraction occasionally, the
force of the reflex is not sufficient to move the limb
o Sometimes, the patient is unable to relax
inhibits the reflex even if pt is neurologically intact. If
this occurs, use REINFORCEMENT.
o Occasionally, it will not be possible to elicit
reflexes, even when no neurological disease
exists most commonly due to inability to relax.
Absence of reflex is of no clinical consequence,
assuming that you were thorough in the history taking,
used appropriate examination techniques, and
identified no evidence of disease
BRAINSTEM REFLEXES
Direct Pupillary
bright light is shone upon the
Reaction to Light
retina iris constricts
Consensual Pupillary
stimulation of one retina
Reaction to Light
contralateral constriction of
the pupil
Ciliospinal Reflex
pinching the skin of the back of
neck papillary dilatation
Corneal Reflex
touching the cornea
blinking of the eyelids
Orbicularis Oculi Reflex
retina is exposed to bright light
eyelids close
Auditocephalogyric
loud sound head and eyes
Reflex
turn to source
Jaw Reflex
mouth is partially opened and
the muscles relaxed + tapping
the chin the jaw to close.
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2.3-C
August 11, 2014
PLM CM
REFLEX TESTING
Dr. Guzman
Gag Reflex
Chewing reflex
*Seen in
dementia, general
paresis, and
anoxic
encephalopathy
Superficial Reflexes
Reflex
Upper
abdominal skin
reflex
Mid abdominal
skin reflex
Segment
T5-T8
Bates: T8-T10
T9-T11
Lower
abdominal skin
reflex
T11-T12
Bates: T10-T12
Cremasteric
reflex
L1-L2
Plantar reflex
L4-S2
Bates: L5, S1
Superficial anal
reflex
L1-L2
Bates: S2-S4
Glabellar reflex
Snout reflex
Sucking reflex
Corticopontine
Corticopontine
Frontal cortex
Procedure &
Expected
Response
With patient
supine, stroke the
skin with blunt
handle towards
the midline
Ipsilateral
contraction of
muscles or
umbilical deviation
towards the
stimulated side
Stroke the inner
aspect of the thigh
from the pubis
distad
Prompt elevation
of the testis on the
ipsilateral side
Stroke the sole
near its lateral
aspect from the
heel towards toes
Plantar flexion of
the toes
Stroke the skin of
the perianal region
External anal
sphincter
contracts
Lightly tap the
forehead between
the eyebrows with
the fingers
(ABNORMAL)
Persistent
blepharospasm
and closing of the
eyes
Tap the nose
(ABNORMAL)
Excessive
grimace of the
face
Stroke the lip with
the finger or a
tongue depressor
(ABNORMAL)
Lips pout and
make sucking
movements
*Present in infants
but disappears
after weaning;
reappears in
diffuse lesions of
Frontotemporal
cortex
(ABNORMAL)
Chewing
movement of the
teeth and jaw
GRASP REFLEX
Stroke the patients palm so he/she grasps your index
finger
If present, the patient cannot release the fingers; lesions
of the premotor cortex
HOFFMANS SIGN
Have patient present pronated hand with fingers extended
and relaxed
With your thumb, press his/her fingernails to flex the
terminal digit and stretch the flexor
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2.3-C
August 11, 2014
PLM CM
REFLEX TESTING
Dr. Guzman
Abnormal response: flexion and adduction of thumb
MAYERS REFLEX
Have patient present his/her supinated hand with thumb
relaxed and abducted
Grasp the ring finger
and firmly flex the
metacarpophalangeal joint
Normal response: adduction and apposition of the thumb
PALM-CHIN REFLEX
Aka Radovicis sign
Vigorous scratching or pricking of the thenar eminence
causes ipsilateral contraction of the muscles of the chin
Spinal rigidity
Kernigs sign
Brudzinskis sign
Spinal Levels
C5-C6
C5-C6
C6-C7
L2-L4
Primarily S1
Spinal Levels
T8-T10
T10-T12
L5-S1
S2-S4
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