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Assessing Reflexes

 
 
 
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Overview

  • 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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