Demonstration of Deep Tendon Reflexes

Introduction

• Importance of proper positioning of the patient
• Understanding the level being tested
• Use of appropriate tools (Queen's Square Hammer is recommended)

Tools

• Queen's Square Hammer is used for testing reflexes.
  • Recommended because of its flexibility

Reflex Testing

1. Brachioradialis Reflex (C5-6)

• Tap on the tendon, not the muscle
• Focus on muscle contraction rather than movement

2. Biceps Reflex (C5-6)

• Hand placement on the biceps tendon
• Strike thumb and observe contraction
• Keep focus on muscle contraction for depressed reflexes

3. Triceps Reflex (C6-7-8)

• Multiple methods of testing:
  • Leave arm in relaxed position
  • Suspend arm and instruct patient to lean on hand
• Strike triceps tendon

4. Finger Flexion Reflex

• Significant if present on one side only
• Hand supported by thigh, relaxed fingers
• Tap to see brisk finger movements

5. Ankle Reflex (S1)

• Testing can be tricky if not brisk
• Ensure foot is loose, apply slight tension
• Strike Achilles tendon
• Observe muscle contraction and movement

6. Knee Reflex

• Patient should be seated and relaxed
• Hit patellar tendon
• Focus on contraction of quadriceps muscle

Ankle Reflex in Bedridden Patients

• Different methods for testing:
  • Bar with fingers across metatarsal heads, slightly cock foot
  • Outwardly rotate hip, flex knee slightly
  • Cross feet to prevent muscle contraction, apply slight tension

Key Points

• Focus on muscle contraction over movement
• Proper technique is crucial for accurate assessment
• Test reflexes methodically and observe carefully

Conclusion

• Accurate assessment requires attention to detail and proper use of tools

Note: This lecture is copyrighted by the Board of Trustees of the Leland Stanford Jr University. Visit med.stanford.edu for more information.