Reflexes

Question 1

PART 1- GENERAL INFO

Answer 1

PART 1- GENERAL INFO

Question 2

Why do we test reflexes?

Answer 2

The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions.

Question 3

What is the grading of reflexes?

Answer 3

• 0 = absent
• 1+ = hypoactive
• 2+ = normal
• 3+ = hyperactive
• 4+ = hyperactive w/ clonus
• 5+ = sustained clonus

Question 4

• UMN = _______reflexia

- LMN = _______reflexia

Answer 4

• UMN = hyperreflexia

- LMN = hyporeflexia

Question 5

What are the 2 types of reflexes tested?

Answer 5

• Deep Tendon Reflexes (DTR)

- Pathological Reflexes

Question 6

What is a tip to eliciting UE DTRs?

Answer 6

Have patient cross legs to cause focus away from UE.

Question 7

What is a tip to eliciting LE DTRs?

Answer 7

Have patient clasp hands and pull to cause focus away from LE.

Question 8

PART 2- DTRs

Answer 8

PART 2- DTRs

Question 9

What are the 5 main DTRs tested and their associated nerve roots?

Answer 9

• Biceps (C5/C6)
• Brachioradialis (C6)
• Triceps (C7)
• Patellar (L4)
• Achilles Tendon (S1)

Question 10

How do we test the biceps reflex?

Answer 10

1. ) Have patient flex arm and find tendon in cubital fossa.
2. ) Push thumb firmly over tendon and strike own finger with reflex hammer.
3. ) Should see contraction of biceps muscle eliciting elbow flexion.

Question 11

How do we test the brachioradialis reflex?

Answer 11

1. ) Have patient lift thumb and find muscle belly a few inches proximal to the distal radius.
2. ) Strike reflex hammer directly over radius where muscle/tendon is located.
3. ) Should see slight flexion/flicker of thumb.

Question 12

How do we test the triceps reflex?

Answer 12

1. ) Have patient extend arm and find the triceps muscle/tendon proximal to the olecranon.
2. ) Support patients humerus and strike reflex hammer directly over the tendon.
3. ) Should see contraction of triceps causing extension of arm.

Question 13

How do we test the patellar reflex?

Answer 13

1. ) Find the patellar tendon just inferior to the patella.
2. ) Strike on patellar tendon distally to inferior border of the patella.
3. ) Should see extension of knee.

Question 14

How do we test the achilles tendon reflex?

Answer 14

1. ) Find the achilles tendon via palpation proximal to the bony borders of the calcaneous.
2. ) Apply slight DF to patient foot and strike achilles tendon.
3. ) Should feel/see PF of the foot.

Question 15

PART 3- PATHOLOGICAL REFLEXES

Answer 15

PART 3- PATHOLOGICAL REFLEXES

Question 16

What are the 4 main Pathological Reflexes?

Answer 16

1. ) Hoffman’s SIgn
2. ) Inverted Supinator Sign
3. ) Babinski’s Sign
4. ) Ankle Clonus

Question 17

Hoffman’s Sign:

• What is a positive Hoffman’s Sign?
• What does a positive Hoffman’s Sign indicate?

Answer 17

• The presence of Hoffmann’s sign is characterized by flexion and adduction of the thumb and flexion of the index finger when flicking the middle finger.
• A positive Hoffman sign indicates an upper motor neuron lesion and corticospinal pathway dysfunction likely due to cervical cord compression.

Question 18

Inverted Supinator Sign:

• What is a positive Inverted Supinator Sign?
• What does a positive Inverted Supinator Sign indicate?

Answer 18

• Rapid finger flexion when applying quick series of taps proximal to radial styloid process while in slight pronation.
• Indicates a lesion at the C5-C6 spinal cord level.

Question 19

Babinski’s Sign:

• What is a positive Babinski’s Sign?
• What does a positive Babinski’s Sign Indicate?

Answer 19

• The big toe moves upward or toward the top surface of the foot while the other toes fan out when the foot is strokes from the heel to the base of the toes, then across the toes.
• It is a sign of a problem in the central nervous system (CNS), most likely in the pyramidal tract.

Question 20

Ankle Clonus

• What is a positive ankle clonus?
• What does ankle clonus indicate?

Answer 20

• > 3 beats of clonus

- Interruption of the upper motor neuron fibers.