Start studying clinical assessment deep tendon reflexes. Motion analysis of normal patellar tendon reflex volume 40 issue 6 lai kuan tham, noor azuan abu osman, wan abu bakar wan abas, kheng seang lim skip to main content accessibility help we use cookies to distinguish you from other users and to. Clinical availability of the deep tendon reflex test using. Tendon reflexes 72 deep tendon reflexes h kenneth walker. Deep tendon reflexes questions and study guide quizlet.
Yet, the literature provides scant information on the physiology, proper technique, and research issues associated with deep reflexes. In a screening examination you will usually find it more convenient to integrate the reflex examination into the rest of the examination of that part of the body. An abnormal reflex helps us locate a pathologic lesion. Study 21 terms reflex assessment flashcards quizlet. Despite being an established technique clinically, there is lack of normality data in the healthy population, especially among the elderly. What are the fallacies in testing the tendon reflex. Eliciting the deep tendon reflexes is a vital component of medical. A reflex hammer holder was built in the project followed by patellar tendon reflex data collection and analysis using the motion analysis system. Hit area below the kneecap with a reflex hammer patellar tendon causes the quadriceps muscle in the thigh to contract, leg kicks out. Local diminishment or absence, suggests a disturbance in the continuity of the reflex arc afferent nerve, motor center, efferent nerve. Nerve impulses follow nerve pathways as they travel through the nervous system. A stretch reflex is an involuntary reaction of a muscle to being passively stretched by percussion of the tendon. The triceps reflex is measured by striking the triceps tendon directly with the hammer while holding the patients arm with your other hand. Assessing deep tendon, superficial, and brain stem reflexes deep tendon reflexes include the triceps, biceps, brachioradialis, patellar, and the achilles tendon.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. Deep tendon reflexes clinical methods ncbi bookshelf. Doctors give trusted, helpful answers on causes, diagnosis, symptoms, treatment, and more. As in muscle strength testing, it is important to compare each reflex immediately with its contralateral counterpart so that any asymmetries can be detected. Tendon reflex definition of tendon reflex by medical dictionary. During the clinical examination of deep tendon reflexes, it is important to identify and document specific levels of reflex responsiveness that are normal for the patient being examined. The simplest of these pathways, including a few neurons. Mar 23, 2016 nursing head to toe assessment includes the deep tendon reflex examination of the biceps tendon c5 to c6 with a reflex hammer. Clinical assessment deep tendon reflexes questions and.
Cultivating expert technique in dtr assessment is possible. Deep tendon reflex article about deep tendon reflex by. Deep tendon reflex article about deep tendon reflex by the. Although the reflex has a sensory and motor component, deep tendon reflex. Increased reflexogenic zone tapping the clavicle reflex spread finger flexion brachioradialis tapping just above the styloid process of the radius. In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a twoneuron reflex arc involving the spinal or brainstem segment that innervates the muscle. Motion analysis of normal patellar tendon reflex canadian. Lower motor neuron lesions eg affecting the anterior horn cell, spinal root or peripheral nerve depress reflexes. Clinical availability of the deep tendon reflex test using a.
When these reflexes are disrupted, hyperreflexia disease induced or hyporeflexiaareflexia drug induced occurs. Strike the tendon roughly 3 inches above the wrist. The 2hour fall risk assessment attempts to identify potential causes for falls and includes evaluations of vital signs, visual acuity and depth perception, and deep tendon reflexes. However, this procedure will be useful in guiding the selection of additional tests and measures and will provide helpful information when reassessed over a. The first thing is to use a reflex hammer, not a finger or a stethoscope. Deep tendon reflex also usually refers to this sense. As in muscle strength testing, it is important to compare each reflex immediately with its. Although nurses perform deep tendon reflex assessments regularly, it is difficult to incorporate theoretical principles in these assessments because of scant medical literature, a. Clasification of reflexes superficial reflexes plantar,abdominal,njuctival,cremastric deep reflexes biceps,triceps,knee,ankle jerks spinal cranial 6. A deep tendon reflex is dependent upon the following. Patient evaluated for deep tendon reflexes and clonus in lower extremities. Aug 16, 2010 in a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a twoneuron reflex arc involving the spinal or brainstem segment that innervates the muscle. Stretch and deep tendon reflexes for skeletal muscles to perform normally.
The limbs should be in a relaxed and symmetric position, since these factors can influence reflex amplitude. At this point, the deep tendon reflex is most likely to be the strongest in which of the following locations. Check the deep tendon reflexes using impulses from a reflex hammer to stretch the muscle and tendon. Deep tendon reflexes dtr deep tendon reflexes, more properly referred to as muscle stretch reflexes, are an integral part of the neurological examination. The stretch reflex myotatic reflex is a muscle contraction in response to stretching within the muscle. Deep tendon reflexes, more properly referred to as muscle stretch reflexes.
The deep tendon reflex dtr test is widely used as an initial exam to identify the presence of potential neurological problems and to assess the severity of neurological disease 1, 2. As in muscle strength testing, it is important to compare each reflex immediately with its contralateral counterpart so that any. Deep tendon response ankle reflex sacral 1 primarily knee reflex lumbar 2,3,4 supinator brachioradialis reflex cervical 5, 6 biceps reflex cervical 5, 6 triceps reflex cervical 6, 7. Contracting the muscle activates the golgi tendon organs. Kenneth walker definition in a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a twoneuron reflex arc involving the spinal or brainstem segment that innervates the muscle. In your own words describe what deep tendon reflexes are.
You should ask the patient to hold the two hands apart. There are five deep tendon reflexes and a number of superficial and visceral reflexes covered here. Golgi tendon reflex the opposite of the stretch reflex. The patellar deep tendon reflex involves the sensory and motor nerve fibers associated with spinal segments l2, l3, and l4. Deep tendon reflexes are important physical signs in neurological examination. Tone is defined as the resistance of muscle to passive elongation or stretch.
Pdf the deep tendon reflex responses are judged by clinicians through visual observation with great variations between different examiners leading to. This stanford medicine 25 video was created in conjunction with stanfords aim lab teaching the examination of the deep tendon reflexes. A deep tendon reflex is often associated with muscle stretching. Although deep tendon reflexes arent routinely assessed, they should be tested in any patient with a spinal cord injury. Deep tendon reflexes deep tendon muscle stretch reflex testing evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending motor pathways. Triceps, biceps, brachioradialis, patellar knee, achilles deep tendon reflexes for the. Deep tendon reflexes stanford medicine 25 stanford. A spinal reflex is a fast response that involves an afferent signal into the spinal cord and an efferent signal out to the muscle. Reflex exam deep tendon reflexes stanford medicine 25. The patellar tendon reflex is an example of the stretch reflex. Deep tendon reflex examination performed in isolation will only provide a limited amount of information relative to function and pathology. It represents a state of slight residual contraction in normally innervated, resting muscle, or steadystate contraction. Testing deep tendon reflexes is an important part of the newborn neurological exam.
The nurse holds the patients relaxed arm with elbow flexed at a 90degree angle, places a thumb over a tendon in the antecubital fossa, and strikes the thumb with the pointed end of the reflex hammer. Assessment of deep tendon reflexes dtrs is a skill we use daily in our clinical practice. The stretch reflex can be a monosynaptic reflex which provides automatic regulation of skeletal muscle length, whereby the signal entering the spinal cord. The muscle stretch myotatic reflex is a simple reflex, with the receptor neuron having direct connections to the muscle spindle apparatus in the muscle and with the alpha motor neurons in the central nervous system that send axons back to that muscle figure 81. Although nurses perform deep tendon reflex assessments regularly, it is difficult to incorporate theoretical principles in these assessments because of scant medical literature, a lack of nursing research, and time constraints in nursing programs. Comprehensive deep tendon reflex examination of the. In the preliminary stage, the motion analysis system was used to collect quantitative data for patellar tendon reflex, one of the deep tendon reflex obtained in human. While eliciting reflex in upperlimb patient may be asked to. The deep tendon reflex responses are judged by clinicians through visual observation with great variations between different examiners leading to high possibilities of errors. Deep tendon reflex examination for nursing head to toe. A common example is the standard patellar reflex or kneejerk response.
Sep 23, 2014 motion analysis of normal patellar tendon reflex volume 40 issue 6 lai kuan tham, noor azuan abu osman, wan abu bakar wan abas, kheng seang lim. Nick deep tendon reflexes demonstrate the homeostasis between the cerebral cortex and the spinal cord. It is expected that the range of normal responses will vary between individuals, will often differ between the upper and lower extremities, and may be affected. Nurses do not routinely assess the deep tendon reflexes unless they work in settings such as labor and delivery or neurology or a patients condition. Triceps, biceps, brachioradialis, patellar knee, achilles deep tendon reflexes for the nursing head to toe assessment of the neuro system. Lower motor neuron lesions eg, affecting the anterior horn cell, spinal root, or peripheral nerve depress reflexes. Reliability of assessment of lower extremity dtrs is higher than that of upper. Option b is the correct technique for assessing the biceps deep tendon reflex.
The article provides information on why the term deep tendon reflex is a misnomer, why tendons move when tapped, where to assess dtrs, and how to assess. These conditions usually result in oneonone training, causing reduced consistency. Reflexes are useful for the general internist to perform, but you cant evaluate them if. Note that the reflex response depends on the force of the stimulus. A stretch reflex, when the stretch is created by a blow upon a muscle tendon. How to assess reflexes msd manual professional edition. Using a reflex hammer, deep tendon reflexes are elicited in all 4 extremities. Pdf assessment of deep tendon reflexes by motion analysis. What are deep tendon reflexes and how they are graded. Diagnostic checklist, medical tests, doctor questions, and. Its synergists contract and its antagonists are inhibited. Feb 17, 2015 the deep tendon reflex dtr test is widely used as an initial exam to identify the presence of potential neurological problems and to assess the severity of neurological disease 1, 2.
This assessment is usually conducted during the headtotoe nursing assessment. Anatomical classification segmental intersegmental suprasegmental 7. Photographic manual of regional orthopaedic and neurological tests 3rd ed. Postural tone a pattern of muscular tension that exists throughout the body and affects groups of muscles. The biceps reflex is tested by supporting the patients arm, with it flexed at roughly 60 degrees, placing your thumb over the biceps tendon and hitting your thumb with the tendon hammer. Nov 28, 2016 muscle tone and deep tendon reflex assessment 1. Choose from 437 different sets of deep tendon reflexes flashcards on quizlet. Upper limb neurological examination neurology osce. Deep tendon reflexes stanford medicine 25 stanford medicine. Triceps, biceps, patellar knee and ankle are the most commonly tested and are graded 04 as follows. In a screening examination you will usually find it more convenient to integrate the.
Understanding deep tendon reflexes a quick tap on a tendon, such as the patellar tendon below the knee cap, will elicit a reflexive contraction of the quadriceps muscle. Deep tendon reflexes, of which the kneejerk is the best known, are spinal reflexes triggered by hitting certain tendons. In addition, the dtr test is one of many methods that can be used to diagnose upper and lower motor neuronal disorders 3. Reflex testing deep tendon muscle stretch reflexes. May 01, 2003 deep tendon reflexes demonstrate the homeo. The deep tendon reflex if you tap on the tendon of a muscle, it contracts. Wide range of normality in deep tendon reflexes in the. Location of abnormal reflexes may be helpful in identifying neurological pathologies of the spine.
The reflex exam is fundamental to the neurological exam and important to. It is vital to get your patient to relax as much as possible and. Note the extent or power of the reflex, both visually and by palpation of the tendon or muscle in question. In general however, deep tendon reflexes are rarely absent in normal persons if the technique of eliciting them is adequate. Apr 01, 2016 comprehensive deep tendon reflex examination of the. Please practice handwashing and social distancing, and check out our resources for adapting to these times. All of the commonly used deep tendon reflexes are presented here in a group. This nursing skills video will show you how to properly elicit a. List of 72 disease causes of hypoactive deep tendon reflexes, patient stories, diagnostic guides. Evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending motor pathways. Assessment of deep tendon reflexes by motion analysis.
The biceps and brachioradialis reflexes are mediated by the c5 and c6 nerve roots. The contraction occurs because the quick tapping on the tendon results in a stretch of the muscle spindles running parallel to the muscle fibers. Famous physical therapists brad heineck and bob schrupp provide a brief overview on testing deep tendon reflexes. Deep tendon reflexes upper extremity reflex mech response nerve supply biceps tapping over a finger placed on the biceps tendon while arm semiflexed elbow flexion c 56 exaggerated reflex.
Deep tendon reflexes are a tendon stretching stimulating the receptor in a certain muscle group, this then initiates a reflex that makes the muscle move. Deep tendon reflex how is deep tendon reflex abbreviated. Deep tendon reflex definition of deep tendon reflex by. There are five deep tendon reflexes and a number of superficial and visceral. Nursing assessment for the deep tendon reflexes for the headtotoe assessment. As in muscle strength testing, it is important to compare each reflex immediately with its contralateral counterpart so that any asymmetries can be. Deep tendon reflex definition of deep tendon reflex by the.
Loss, when associated with exaggeration of deep tendon reflexes implies a pyramidal tract lesion. Learn deep tendon reflexes with free interactive flashcards. The deep tendon reflex examination is part of the neuro assessment for the nursing head to toe assessment. The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions.