Muscle, Superficial, and Pathological Reflexes Flashcards
Biceps Brachii Reflex peripheral innervation
Musculocutaneous nerve
Biceps Brachii Reflex segmental innervation
C5-6
Brachioradialis Reflex segmental innervation
C5-6
Brachioradialis Reflex peripheral innervation
Radial nerve
Triceps Brachii Reflex segmental innervation
C6-7-8-(T1)
Triceps Brachii Reflex peripheral innervation
Radial nerve
Finger flexion Reflex segmental innervation
C7-8-T1
Finger flexion Reflex peripheral innervation
Median and ulnar nerves
Patellar Reflex segmental innervation
L2-3-4
Patellar Reflex peripheral innervation
Femoral nerve
Achilles Reflex segmental innervation
L5-S1-2
Achilles Reflex peripheral innervation
Tibial nerve
Adductor Reflex segmental innervation
L2-3-4
Adductor Reflex peripheral innervation
Obturator nerve
Internal Hamstring Reflex segmental innervation
L4-5-S1-2
Internal Hamstring Reflex peripheral innervation
Tibial nerve
External Hamstring Reflex segmental innervation
L5-S1-2-3
External Hamstring Reflex peripheral innervation
Common Peroneal/fibular nerve
Reflex grade 0 (0)
Absent with reinforcement
Reflex grade 1 (+)
Hypoactive with reinforcement
Reflex grade 2 (++)
Normal - May use sluggish or brisk
Reflex grade 3 (+++)
Hyperactive
Reflex grade 4 (++++ with transient clonus)
Hyperactive with transient clonus
Reflex grade 4 (++++ with sustained clonus)
Hyperactive with sustained clonus
Method of Jendrassik
When testing the patellar reflexes the patient is asked to hook his fingers and try to pull them apart at the time the reflex is being tested. Reinforcement can be done in a number of ways by distracting the patient while performing the reflex.
Gag reflex segmental and peripheral innervations
CN IX and X for both
Corneal blink reflex segmental and peripheral innervations
CN V and VII for both
Epigastric reflex segmental and peripheral innervations
T5-7
Intercostal nerves
Upper Abdominal segmental and peripheral innervations
T7-9
Intercostal nerves
Middle Abdominal segmental and peripheral innervations
T9-11
Intercostal nerves
Lower Abdominal Reflex segmental and peripheral innervations
T11-12
Intercostal, Ilioinguinal, and Iliohypogastric nerves
Cremasteric Reflex segmental and peripheral innervations
L1-2
Ilioinguinal and genitofemoral nerves
Gluteal Reflex segmental and peripheral innervations
L4-5-S1-2
Inferior gluteal nerve
Plantar Reflex segmental and peripheral innervations
L4-5-S1-2
Tibial nerve
Anal Reflex segmental and peripheral innervations
S2-3-4
Inferior hemorrhoidal nerve
Hoffman Sign
Segmental level
Procedure
Response and indications
Segmental level: lesion above C5 in corticospinal tract
Procedure: sharp forcible flick of Dr’s thumb against pt’s middle finger
Response and indications: flexion of fingers and Adduction of thumb; UMNL
Tromner Sign
Segmental level
Procedure
Response and indications
Segmental level: lesion above C5 in corticospinal tract
Procedure: tap volar surface of middle finger
Response and indications: flexion of fingers and Adduction of thumb; UMNL
Rossolimo Sign of the Foot
Segmental level
Procedure
Response and indications
Segmental level: corticospinal tract
Procedure: tap ball of the foot or tips of the toes
Response and indications: plantarflexion of toes; UMNL
Babinski sign
Segmental level
Procedure
Response and indications
Segmental level: corticospinal tract
Procedure: stroke plantar of foot from heel to metatarsals to big toe
Response and indications: normal = plantar flexion of toes and foot
abnormal = dorsiflexion of big toe and flaring of other toes; UMNL
Chaddock sign
Segmental level
Procedure
Response and indications
Segmental level: corticospinal tract
Procedure: stroke lateral malleolus from heel to toe
Response and indications: normal = no motion of toes and foot
abnormal = dorsiflexion of big toe and flaring of other toes; UMNL
Oppenheim sign
Segmental level
Procedure
Response and indications
Segmental level: corticospinal tract
Procedure: stroke anterior tibial surface from superior to inferior
Response and indications: normal = no motion of toes and foot
abnormal = dorsiflexion of big toe and flaring of other toes; UMNL
Gordon sign
Segmental level
Procedure
Response and indications
Segmental level: corticospinal tract
Procedure: squeeze the calf
Response and indications: normal = no motion of toes and foot
abnormal = dorsiflexion of big toe and flaring of other toes; UMNL
Schaeffer sign
Segmental level
Procedure
Response and indications
Segmental level: corticospinal tract
Procedure: squeeze the Achilles’ tendon
Response and indications: normal = no motion of toes and foot
abnormal = dorsiflexion of big toe and flaring of other toes; UMNL
Pupillary Light Reflex
Segmental level
Procedure
Response and indications
Segmental level: afferent CN II, efferent CN III
Procedure: shine light into one eye watch for constriction of both eyes. Repeat on other eye.
Response and indications: should see bilateral constriction. If not may be CN II or CN III lesion
Accommodation Reflex
Segmental level
Procedure
Response and indications
Segmental level: CN III
Procedure: have patient look at finger 2 ft away, then follow it in to about 6” away from nose, then look away at a far object.
Response and indications: convergence of eyes, constriction of pupils, lens thickening. CN III lesion
Ciliospinal Reflex
Segmental level
Procedure
Response and indications
Segmental level: afferent CN V and cervicals, efferent cervical sympathetics
Procedure: painful stimulus to the neck
Response and indications: dilation of the pupil on the painful side of stimulation. If absent may be lesion of the cervical sympathetics
Oculocardiac Reflex
Segmental level
Procedure
Response and indications
Segmental level: afferent CN V, efferent CN X
Procedure: thumb pressure on the eyeballs
Response and indications: decrease in heart rate and a fall in blood pressure
Carotid Sinus Reflex
Segmental level
Procedure
Response and indications
Segmental level: afferent CN IX, efferent CN X
Procedure: pressure on the carotid sinus (unilateral or bilateral)
Response and indications: decrease in heart rate and a fall in blood pressure
Bulbocavernosus Reflex
Segmental level
Procedure
Response and indications
Segmental level: S3-4
Procedure: stroke, prick, pinch the dorsum of the glans penis
Response and indications: contraction of the bulbocavernosus muscle and urethral constriction, and contraction of the external anal sphincter