Diabetic Exam

Assessing Reflexes



    • How to Elicit

    • Biceps - ask the patient to relax their arms in their lap and strike the biceps tendon with a tendon hammer.
    • Supinator - ask the patient to relax their arms in their lap and strike the brachioradialis tendon, proximal to the wrist on the lateral aspect of the forearm.
    • Triceps - lift the patient’s shoulder into abduction and internal rotation, with the arm flexed to 90°. Strike the triceps tendon with a tendon hammer.
    • Patellar - with the patient supine, support the knee from underneath providing slight flexion and strike the patellar tendon below the patella.
    • Achilles - flex the knee, externally rotate the hip and dorsiflex the foot. Strike the Achilles tendon of the heel.
  • If the reflex is difficult to elicit, reassess the reflex while the patient clenches their teeth.
    • Interpretation

    • 0
      No response (hyporeflexive)Lower motor neuron lesion
    • 1+
      Diminished (low normal)Lower motor neuron lesion
    • 2+
      Average (normal)
    • 3+
      Brisk (high normal)Upper motor neuron lesion
    • 4+
      Very brisk (hyperreflexive)Upper motor neuron lesion
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