Assessing Deep Tendon Reflexes

Introduction

• Presenter: Sarah from RegisteredNurseRN.com
• Purpose: Overview and demonstration of assessing deep tendon reflexes for nursing students and nurses.
• Required Tool: Reflex hammer

Importance of Assessing Deep Tendon Reflexes

• Evaluates lower motor neurons/fibers at specific spinal levels.
• Part of neurological assessments during nursing evaluations.
• More common in certain nursing specialties (e.g., neuro, labor and delivery).
• Example: Preeclampsia in pregnant women can cause hyperactive deep tendon reflexes.
• Check reflexes in cases of electrolyte imbalances for baseline comparison.

Grading Deep Tendon Reflexes

• 4+: Hyperactive, clonus
• 3+: Brisker than normal, hyperreflexive
• 2+: Normal (desired outcome)
• 1+: Diminished, hyporeflexive
• 0: Absent reflex
• Importance of practice to understand grading due to subjective nature.

Techniques for Eliciting Reflexes

• Swing reflex hammer briskly.
• Do not let hammer rest on tendon post-strike.
• Ensure correct tendon is targeted.
• Locating tendon: Patient flexes muscle to identify cord-like area.

Specific Reflex Tests

Bicep Tendon Reflex

• Location: Below bicep muscle, antecubital fossa.
• Nerve Roots Tested: C5-C6
• Procedure:
  • Find tendon by having patient flex bicep.
  • Place thumb over tendon, patient relaxes arm over lap.
  • Strike with hammer, look for bicep contraction, forearm flexion.

Tricep Tendon Reflex

• Location: Back of arm, above elbow.
• Nerve Roots Tested: C7-C8
• Procedure:
  • Extend arm to find tendon above elbow.
  • Let arm hang limp, strike tendon.
  • Look for forearm extension, tricep contraction.

Brachioradialis Tendon Reflex

• Location: Above radial styloid process on wrist.
• Nerve Roots Tested: C5-C6
• Procedure:
  • Find radial styloid process, move 2-3 cm above.
  • Patient turns thumb upward, relaxes arm on leg.
  • Strike tendon, look for hand supination, forearm flexion.

Patellar Tendon Reflex

• Location: Below knee cap.
• Nerve Roots Tested: L2-L4
• Procedure:
  • Locate tendon below kneecap.
  • Support knee, have leg extended.
  • Strike tendon, observe lower leg extension.

Achilles Tendon Reflex

• Location: Above heel.
• Nerve Roots Tested: L5-S2
• Procedure:
  • Patient's feet dangle, dorsiflex foot.
  • Locate tendon above heel.
  • Strike tendon, look for plantar flexion.

Conclusion

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