Reflexes - Superficial and Deep tendon reflexes

Reflexes - Superficial and Deep tendon reflexes

1. SHORT TOPIC – REFLEXES guide- dr. ram. kaulgud student- dr. rahul s. belavi

2. Defination : A Reflux is an involuntory response to a sensory stimulus. - Dejongs Neurological Examination 7 th Edition.

3. REFLEX ARC : It is a basic unit of integrated reflex activities. Components of Reflex arc, Receptor –Muscle spindle Affarent - Ia,II fibres Centre - Spinal Cord Effarent - Motor nerve Effector - Extrafusal fibre.

4. Classification of Reflexes : Clinical Anatomical Number of Synapses Functional

5. Clinical classification of Reflexes: Deep Superficial Pathological

6. Grading of Reflexes: 0 – Absent 1 – Present but diminished 2 – Normal 3 - Exaggerated 4 – Clonus.

7. Prerequisite before eliciting Reflexes; Patient should be comfortable and relaxed. Optimal positioning. Adequate exposure of muscle to be tested. Clear instructions to the patient. Proper technique - - A good percussion hammer. - Examiner with a flexible wrist. - Adequate stimulus.

8. Hyperreactive Reflexes; - Decrease in latency - Decrease in reflex threshhold - Exaggeration of range of motion - Prolongation of muscular contraction - Extension of the reflexogenic zone

9. Exaggeration of DTRs seen in, - UMN lesion - Anxiety - Fright - Agitation - Psychogenic disorder.

10. Hypoactive Reflexes; - Decreased range of motion - Increase in the stimulus intensity needed to elicit the response.

11. Diminition of DTRs seen in , - Breach in the reflex arc - Spinal shock - Deep coma - Deep sleep - Heavy sedation - Narcosis - Spinal anaesthesia

12. DEEP REFLEXES 1- The Biceps Jerk: Segmental innervation – C5, C6 Peripheral nerve – Musculocutaneous nerve.

13. 2- The Supinator Jerk: Segmental innervation – C5, C6 Peripheral nerve – Radial nerve

14. 3- The Triceps Jerk: Segmental innervation – C7, C8 Peripheral nerve – Radial nerve

15. 4- The Pectoral Reflex: Segmental innervation : C5-T1. Peripheral nerve – Lateral & medial pectoral nerve.

16. 5. The Finger flexion Reflex: Segmental innervation : C6-T1 . Peripheral nerve – Median nerve.

17. 6- The Knee Jerk: Segmental innervation – L3, L4 Peripheral nerve – Femoral nerve

18. 7- The Ankle Jerk: Segmental innervation – S1 Peripheral nerve – Medial popliteal nerve

19. SUPERFICIAL REFLEXES 1- The Abdominal Reflexes, Segmental innervation: T7-T12

20. 2- The Cremasteric Reflex: Segmental innervation : L1, L2 3- The Anal Reflex: Segmental innervation : S4, S5

21. 4 -The Plantar Reflex: Segmental innervation: L4-S2 Peripheral nerve – Medial popliteal nerve

22. PATHOLOGICAL REFLEXES 1 - The Hoffman reflex : - Upper extremity corticospinal reflex. - Can be present in some normal individuals. - they are of clinical significance only when markedely active.

23. 3 - Tromner Sign : - equivalent response to Hoffmans reflex.

24. 2 - Wartenberg Sign : - Normal response is abduction and extension of thumb .

25. 4 - The Rossilomos reflex: - Plantar flexion of the toes indicates corticospinal tract lesion.

26. 5- Babinskis sign:

27. Schaefers sign:

28. Oppenheim sign:

29. Chaddock sign:

30. CLONUS : It is a series of rhythmic involuntary m uscular contractions induced by a sudden passive stretching of the muscle. 1- Sustained clonus 2- Ill sustained clonus

31. FRONTAL RELEASE SIGNS: 1- Glabellar tap 2- Palmomental reflex 3- Grasp reflex 4- Snout reflex 5- Sucking reflex.

32. Inverted reflexes: It is the contraction of the muscle, opposite of that expected. Ex: Inverted supinator reflex Inverted Biceps reflex Inverted Triceps reflex Inverted Knee reflex.

33. Mechanism: In pathological reflexes, the segmental reflex is absent, but there is an underlying hyperreflexia lowering the threshold for activation of the antagonistic muscle, perhaps because of transmitted vibrations. Seen in- Cervical disc disease - Syringomyelia - Cervical neoplasm - Cervical trauma.

34. Thank You.

35. Referances 1 - Dejongs Neurological Examination 7 th Edition . 2 – Bickerstaffs Neurological examination in clinical practice 7 th Edition.