Reflexes Flashcards
PART 1- GENERAL INFO
PART 1- GENERAL INFO
Why do we test reflexes?
The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions.
What is the grading of reflexes?
- 0 = absent
- 1+ = hypoactive
- 2+ = normal
- 3+ = hyperactive
- 4+ = hyperactive w/ clonus
- 5+ = sustained clonus
- UMN = _______reflexia
- LMN = _______reflexia
- UMN = hyperreflexia
- LMN = hyporeflexia
What are the 2 types of reflexes tested?
- Deep Tendon Reflexes (DTR)
- Pathological Reflexes
What is a tip to eliciting UE DTRs?
Have patient cross legs to cause focus away from UE.
What is a tip to eliciting LE DTRs?
Have patient clasp hands and pull to cause focus away from LE.
PART 2- DTRs
PART 2- DTRs
What are the 5 main DTRs tested and their associated nerve roots?
- Biceps (C5/C6)
- Brachioradialis (C6)
- Triceps (C7)
- Patellar (L4)
- Achilles Tendon (S1)
How do we test the biceps reflex?
- ) Have patient flex arm and find tendon in cubital fossa.
- ) Push thumb firmly over tendon and strike own finger with reflex hammer.
- ) Should see contraction of biceps muscle eliciting elbow flexion.
How do we test the brachioradialis reflex?
- ) Have patient lift thumb and find muscle belly a few inches proximal to the distal radius.
- ) Strike reflex hammer directly over radius where muscle/tendon is located.
- ) Should see slight flexion/flicker of thumb.
How do we test the triceps reflex?
- ) Have patient extend arm and find the triceps muscle/tendon proximal to the olecranon.
- ) Support patients humerus and strike reflex hammer directly over the tendon.
- ) Should see contraction of triceps causing extension of arm.
How do we test the patellar reflex?
- ) Find the patellar tendon just inferior to the patella.
- ) Strike on patellar tendon distally to inferior border of the patella.
- ) Should see extension of knee.
How do we test the achilles tendon reflex?
- ) Find the achilles tendon via palpation proximal to the bony borders of the calcaneous.
- ) Apply slight DF to patient foot and strike achilles tendon.
- ) Should feel/see PF of the foot.
PART 3- PATHOLOGICAL REFLEXES
PART 3- PATHOLOGICAL REFLEXES
What are the 4 main Pathological Reflexes?
- ) Hoffman’s SIgn
- ) Inverted Supinator Sign
- ) Babinski’s Sign
- ) Ankle Clonus
Hoffman’s Sign:
- What is a positive Hoffman’s Sign?
- What does a positive Hoffman’s Sign indicate?
- 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.
Inverted Supinator Sign:
- What is a positive Inverted Supinator Sign?
- What does a positive Inverted Supinator Sign indicate?
- 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.
Babinski’s Sign:
- What is a positive Babinski’s Sign?
- What does a positive Babinski’s Sign Indicate?
- 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.
Ankle Clonus
- What is a positive ankle clonus?
- What does ankle clonus indicate?
- > 3 beats of clonus
- Interruption of the upper motor neuron fibers.
