TENDON

REFLEXES
 DEFINITIO
A reflex may be defined as an immediate and involuntaryN
response to a

stimulus.

Sudden stretching of a muscle usually evokes brisk contraction of that muscle

This reflex is usually mediated via a neural pathway synapsing the spinal cord

It is subject to regulation via pathways from the brain

 When a muscle tendon is tapped briskly, the muscle immediately
contracts due to a two-neuron reflex arc involving the spinal or
brainstem segment that innervates the muscle.

The afferent neuron whose cell body lies in a dorsal root ganglion
innervates the muscle or Golgi tendon organ associated with the
muscles

The efferent neuron is an alpha motor neuron in the anterior horn

of the cord. .
 GRADING OF REFLEXES
By convention the deep tendon reflexes are graded as follows:

0 = no response; always abnormal

1+ = a slight but definitely present response; may or may not be normal

2+ = a brisk response; normal

3+ = a very brisk response; may or may not be normal

4+ = a tap elicits a repeating reflex (clonus); always abnormal

Hyporeflexia
ABNORMALITIES
-Absent or diminished response to tapping.

-It usually indicates a disease that involves one or more of the components of the two-
neuron reflex arc itself.

Hyperreflexia

-hyperactive or repeating (clonic) reflexes.

-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.
 JAW JERK/ MASSETER REFLEX
(CN V)
1. Ask the patient to let the mouth fall open slightly
2. Place your finger on the tip of the jaw and tap it lightly with a
tendon hammer

Normal: slight closure of the mouth or no reaction at all

Abnormal: greatly exaggerated in UMN lesion above the pons,
commonly seen in pseudobulbar palsy
 BICEPS REFLEX (C5, C6)
1. Make sure the patient is resting comfortably with the elbows flexed and hands lying pronated on the
lap and not overlapping one another
2. Place one finger on the biceps tendon and tap with tendon hammer

Normal: brisk contraction of the biceps muscle with flexion of the forearm at the elbow, followed by prompt
relaxation
Abnormal:
- Increased jerk occurs d/t UMN lesion
- Decreased/ absent occurs with a breach in
any part o the reflex motor arc
Muscle: myopathy
Motor nerve: neuropathy
Anterior spinal cord root: spondylosis
Anterior horn cell: poliomyelitis
 THE TRICEPS REFLEX (C7, C8)

1. Support the elbow with one hand

2. Tap over the triceps tendon

Normal: triceps contraction which results in forearm extension

 BRACHIORADIALIS REFLEX (C5, C6)

1. Place two finger over the lower end of the radius just above the wrist
2. Tap your fingers with tendon hammer

Normal: contraction of brachoradialis causes flexion of the elbow

Abnormal:
- Inverted brachoradialis (supinator) jerk: only elbow extension and
finger flexion are present
- This is a/w an absent biceps jerk and an exaggerated triceps jerk
- Indicates spinal cord lesion at the C5 or C6 level
- E.g. compression (disc prolapse), trauma
- Occurs because LMN lesion at C5 or C6 is
combined with UMN lesion affecting the reflexes
below this level
 FINGER JERK
1. The patient rests the hand palm
upwards with the fingers slightly
flexed

2. Place hand over the patients and

strike hammer over your fingers

Normal: slight flexion of all the patients

fingers occurs
 KNEE JERK L3, L4
1. Slide one arm under the patients knees so that they are
slightly bent and supported
2. Strike the tendon hammer on the infrapatellar tendon

Normal: contraction of quadriceps extension of knee

 THE ANKLE REFLEX (S1,
S2)
1. Have the foot in the mid position at the ankle with the knee bent,
the thigh externally rotated on the bed and the foot held in
dorsiflexion by you

2. Strike the hammer on the Achilles tendon

Normal: plantar flexion of foot with contraction of gastronecmius

muscle