Ref: Deep Tendon Reflexes
- General considerations
- Upper limb: supinator,
biceps, triceps, fingers
- Lower limb: knees,
ankles, plantar
- Increasing a reflex
- Always compare one side to the other.
- Let hammer fall by gravity in most cases.
- Don't keep hammering a pt, if can't elicit it.
- Pt's elbow at 90°, relaxed
- Hand pronated and resting on pelvis..
- Hammer falls on distal end of radius.
- Pt's elbow still at 90°, relaxed.
- Dr's finger over biceps tendon.
- Hammer falls on Dr's finger.
- Pt's arm crossed over, onto chest.
- Hammer swings into triceps tendon.
- Pt's hand palm up, fingers very slightly flexed.
- Dr's finger pads overlie pt's finger pads.
- Hammer taps Dr's fingers.
- If supine, Dr. lifts both knees with 1 arm, flexing legs slightly.
- Hammer falls on patellar tendon..
- Need ankle and knee joints both now at 90° angle, abducted and externally
rotated. 2 options of doing this:
• Pt's lateral side of heel lies overtop opposite shin. Tell pt:
"Place your heel on your opposite shin".
• Alternatively, patient kneels on bed, feet dangle over edge of bed.
- Dr. grasps end of foot to maintain this position. Since Dr standing on R
side of pt, Dr's with L hand, hold pt's foot with R hand.
- Tap Achilles tendon.
- Tell pt. what about to do.
- Use key to stroke from heel, up lateral sole, then medially across to ball of
foot.
- See if big toe goes up (UMNL) instead of its normal down.
- Alternatively: try with a fingernail first, before the key, so less pain
to pt.
- See UMNL
vs LMNL Reference.
If can't elicit a reflex, can increase its visibility via any of 3 methods.
- Clenching teeth.
- Jendrassik's maneuver:
• Pt clasps hands together tightly.
• Pt. releases hands just before tap hammer.
- Gripping an object.
Obviously, teeth clenching is the only appropriate one while testing upper
limbs.