Deep tendon reflex examination and evaluation study guide, wayne state university department of health care sciences opencourseware. Deep tendon reflexes are best examined with a queen square or troemner hammer while the patient is seated comfortably in the upright position. How to assess reflexes neurologic disorders msd manual. When these reflexes are disrupted, hyperreflexia disease induced or hyporeflexiaareflexia drug i. Deep tendon reflexes stanford medicine 25 stanford. Deep tendon reflexes dtr deep tendon reflexes, more properly referred to as muscle stretch reflexes, are an integral part of the neurological examination. Neurologic exam evaluation checklist neuro osce students.
Examiner elicited the following deep tendon reflexes bilaterally. Assessment of patellar tendon reflex responses using second. Patients with cerebellar injury may have a knee jerk that swings forwards and backwards several times. In addition, the dtr test is one of many methods that can be used to diagnose upper and lower motor neuronal disorders 3. These manual evaluations are convenient but lack accurate measurements for clinical diagnosis and treatment outcome evaluations. Hyperreflexia refers to hyperactive or repeating clonic reflexes. Wide range of normality in deep tendon reflexes in.
This grading has been criticised by bradley, who proposed six grades to give a better description of what is seen clinically. The knee jerk reflex is an example of the stretch reflex and it is used to determine the sensitivity of the stretch reflex. It represents a state of slight residual contraction in normally innervated, resting muscle, or steadystate contraction. Photographic manual of regional orthopaedic and neurological tests. Deep tendon reflexes should be graded on a scale of 04 as follows.
These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways. Tone is defined as the resistance of muscle to passive elongation or stretch. Deep tendon reflexes score builders flashcards quizlet. Grading for commonly elicited deep tendon reflexes. Deep tendon reflexes are actually muscle stretch reflexes mediated through neuromuscular spindles. Deep tendon reflex score tips and tricks from doctors. Deep tendon reflexes na na biceps c5c6 brachioradialis c5c6 triceps c7 patellar l4 achilles s1 reenforcement additional reflexes other types for tests for the same root level advanced imaging referral pathological reflexes na na hoffmans babinskis additional pathological reflexes. Pdf assessment of deep tendon reflexes by motion analysis. Clinical signs may be a better indicator than serum levels of tissue levels of magnesium. Like the patellar or knee reflex can indicate a spinal nerve problem or herniated disc. Observer should note its intensity, rate, rhythm, and if any blood vessel tenderness, tortuosity, or nodularity exists. Remember to hold the reflex hammer lightly between your thumb and index finger and to use your wrist to tap the tendon briskly with a quick, bouncy motion.
You will have to sit down and discuss surgical verses no surgical options with an orthopedic surgeon. Deep reflexes involve receptor organs embedded in the muscle, whereas superficial reflexes have receptor organs embedded in the skin. Pdf the purpose of this study was to assess the between observer reliability of two standard notation scales for grading tendon reflexes, the. 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. Deep tendon reflex grading scale answers on healthtap. Pdf the deep tendon reflex responses are judged by clinicians through visual observation with great variations between different examiners leading to. 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.
Deep tendon reflex rating scale guide text the nervous system. Testing reflexes is the most important element of determining whether weakness is of an upper or lower motor neuron type limited only by the fact that only certain muscles. Start studying deep tendon reflex grading muscle strength grading. The deep tendon reflex if you tap on the tendon of a muscle, it contracts. Deep tendon reflexes in pregnancy antepartum hemorrhage.
Quizlet flashcards, activities and games help you improve your grades. By convention the deep tendon reflexes are graded as follows. When these reflexes are disrupted, hyperreflexia disease induced or. The deep tendon and the abdominal reflexes journal of neurology. Nov 28, 2016 muscle tone and deep tendon reflex assessment 1. Dtr testing is helpful in differentiating between a lesion of the cns upper motor neuron lesion vs.
A tendon reflex is the contraction of a muscle in response to striking its tendon. Deep tendon muscle stretch reflexes evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending motor pathways. Deep tendon reflexes are often rated according to the following scale. Dtr or deep tendon reflex is a test done on physical exam to evaluate specific nerve function. Insult to the cerebellum may lead to pendular reflexes. To test the reflex, the muscle should be in a neutral position.
Clinical availability of the deep tendon reflex test using a. Stam and van crevel 1990 studied reliability issues. Indications for deep tendon reflex examination the examination and evaluation of deep tendon reflexes are indicated for a wide variety of conditions that affect the peripheral nervous system pns, central nervous system cns, or both. Deep tendon reflexes deep tendon muscle stretch reflex testing evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending motor pathways. We assessed the reliability of four neurologists, instructed in two different countries, in using the national institute of neurological disorders and stroke ninds myotatic reflex scale. Lower motor neuron lesions eg affecting the anterior horn cell, spinal root or peripheral nerve depress reflexes. The deep tendon and the abdominal reflexes journal of. Previous studies have demonstrated the usefulness of quantified measurement. Deep tendon reflex scale is commonly used to characterize hyperactive reflexes and modified ashworth scale is used to characterize spasticity in clinical practice. Pendular reflexes are not brisk but involve less damping of the limb movement than is usually observed when a deep tendon reflex is elicited. In addition to clonus, other signs of hyperreflexia include spreading of reflexes to other muscles not directly being tested and crossed adduction of the opposite leg when the medial aspect of the knee is tapped. Although the reflex has a sensory and motor component, deep tendon reflex. May 01, 2014 the pulse and deep tendon reflex grading scale 1. 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.
When the reflexes are absent try eliciting it after reenforcing jendrassik maneuver0, by asking the patient to interlock and pull flexed fingers. Postural tone a pattern of muscular tension that exists throughout the body and affects groups of muscles. The deep tendon reflexes and the abdominal reflexes are important physical signs which have a special place in neurological diagnosis, particularly in early disease when they alone may be abnormal. A satisfactory pulse can be taken radially in children older than 2 yrs old in infants and younger children the apical pulse is more reliable count the pulse for 1 full minute in infants and young children bc of possible. Neurophysiological methods for the assessment of spasticity. Pdf deep tendon reflexes demonstrate the homeostasis between the cerebral cortex and the spinal cord. Patellar tendon reflex as a predictor of improving motor. The deep tendon myotatic reflexes are a critical part of the neurologic examination that is discussed in chapter 8. Glasgow coma scale pupillary responses verbal response spontaneous eye movements eye opening oculocephalic responses motor response caloric responses corneal responses motor function respiratory pattern motor response cheyne stokes. Certain nerves like cervical and lumber spinal nerves control certain reflexes and when absent can indicate a problem with that nerve.
In addition to clonus, other signs of hyperreflexia include spreading of reflexes to other muscles not directly being tested. Mar 16, 2014 this stanford medicine 25 video was created in conjunction with stanfords aim lab teaching the examination of the deep tendon reflexes. Pdf mayo and ninds scales for assessment of tendon reflexes. There are a number of accepted scales for grading deep tendon reflexes. Evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending motor pathways. The perinatal nurse, in collaboration with physicians, can use deep tendon reflexes as a powerful tool in determining the need to start, adjust, or stop magnesium infusion. In a university department of neurology two or three physicians judged the biceps, triceps, knee, and ankle tendon reflexes in two groups of 50 patients using either scale. Despite common acceptance, the grading scales remain subjective, creating an opportunity for quantitative measures to improve the reliability and efficacy of these tests. Reflex exam deep tendon reflexes the reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions. A stretch reflex is an involuntary reaction of a muscle to being passively stretched by percussion of the tendon. They act as hard signs in situations where clinical assessment is complicated by patient anxiety, and become more useful as clinical experience develops.
Deep tendon reflex grading muscle strength grading. The stanford medicine 25 is a stanford school of medicine. Note that the reflex response depends on the force of the stimulus. Diffuse reduction or absence of deep tendon reflexes suggests a more generalized process affecting the peripheral nerve, seen frequently in peripheral neuropathies secondary to diabetes, alcohol abuse, or inflammation. Deep tendon reflexes, more properly referred to as muscle stretch reflexes, are. Deep tendon reflex examination and evaluation study guide. C5c6 with the arm gently flexed at the elbow, tap the biceps tendon with. Deep tendon reflexes demonstrate the homeostasis between the cerebral cortex and the spinal cord. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
When these reflexes are disrupted, hyperreflexia disease induced or hyporeflexiaareflexia drug induced occurs. Deep tendon reflexes score builders study guide by tdkfilms includes 12 questions covering vocabulary, terms and more. Reliability of the ninds myotatic reflex scale neurology. The purpose of this study was to assess the between observer reliability of two standard notation scales for grading tendon reflexes, the mayo clinic scale and the ninds scale. Assessment of hyperactive reflexes in patients with spinal. Deep tendon reflex tests, such as the patellar tendon reflex ptr, are widely accepted as simple examinations for detecting neurological disorders. Although nurses perform deep tendon reflex assessments regularly, it is difficult to incorporate theoretical principles in these assessments because of scant medical literature, a. Motor, reflex, coordination and sensory screening examination. During a reflex test, your doctor tests your deep tendon reflexes with a reflex hammer to measure your response. In general however, deep tendon reflexes are rarely absent in normal persons if the technique of eliciting them is adequate. Brisk reflexes refer to an aboveaverage response during a reflex test. Mayo and ninds scales for assessment of tendon reflexes. Reflexes can be tested as part of a neurological examination, often if there is an injury to the central nervous system. Sep 08, 20 the video covers in detail how to evaluate deep tendon reflexes dtrs, perform an upper and lower extremity sensory exam dermatomes, perform an upper and lower extremity motor exam kendall.
Deep tendon reflexes clinical methods ncbi bookshelf. Whether magnesium is given to prevent seizures or for tocolysis. There are five deep tendon reflexes and a number of superficial and visceral reflexes covered here. Microsoft powerpoint chap 6 reflexes compatibility mode.
Toxicity can be detected using physical manifestations as a guide. The assessment of deep tendon reflexes is useful for localization and diagnosis of neurologic disorders, but only a few studies have evaluated their reliability. The last part of the neurologic exam is checking deep tendon reflexes, or dtrs. This stanford medicine 25 video was created in conjunction with stanfords aim lab teaching the examination of the deep tendon reflexes.
807 694 1313 1186 125 138 161 174 596 407 739 148 438 1358 677 553 1470 511 426 990 1334 734 270 1018 826 738 840 50 1323 717 527 840 663 567 454 777 198 1248 1103 184 755 492 1209