The vertebral column contains the spinal cord, and is the source of the motor innervation to the muscles of our body. Therefore it is often important to test the reflexes - especially if the patient complains of burning, or shooting pain, or numbness.

Above: The common types of reflex hammers seen at Queen's. The selection of a reflex hammer relies on training, skill, and personal preference. Select one that you feel comfortable using.

Begin with the reflexes of the upper extremity. It is best to have the patient seated whist taking the reflexes.

Strike the biceps (C5 and C6) tendon just proximal to where it inserts on the ulna.

Above: Place your thumb over the patient's biceps tendon. This allows you to feel the biceps tendon, and provides a visual target.

Above: Strike your thumb with your reflex hammer to elicit the reflex. The bulk of the biceps will move visibly, and/or the forearm will flex at the elbow slightly if this reflex has been tested properly. This reflex corresponds to nerve roots C5 and C6

Repeat the above for the next arm.

Next, strike the brachioradialis (C5 and 6) tendon just proximal to where it inserts on the radius.

Above: Ask the patient to relax their arm as you place your finger approximately 2cm proximal to the wrist, over the insertion site of the brachioradialis muscle.  Strike your thumb with the reflex hammer, eliciting the reflex. The forearm will flex slightly at the elbow, it will supinate slightly, or the bulk of the brachioradialis will shift. This reflex relies on the C5 and C6 nerve roots.

Above:  If you are having difficulty visualizing the insertion of the brachioradialis muscle, have the patient push up with their forearm while you hold it with your hand.  Then have the patient relax, and examine the reflex.

 

Swtich arms, and continue with the examination.

Next move on to the triceps (C6, C7, and C8) tendon reflex. Ask the patient to relax their arm, as you support it with your hand by holding the biceps.

Above: support the arm so that the patient can relax it fully.

Strike slightly proximal to the olecranon process

Above: striking slightly proximal to the olectranon process will cause the arm to extend reflexively, demonstrating activity at the C6, C7 and C8 nerve roots.

Of course, compare to the opposite side.

The Reflexes of the Lower Extremities

Have the patient relax their legs, and strike the patellar tendon (L2, L3 and L4) distal to the patella.

Above: Be sure to stand just to the side of the patient when taking this reflex, as testing this reflex causes the patient to extend the lower leg at the knee. This reflex relies on the L2, L3, and L4 nerve roots, delivered via the femoral nerve.

 

Above: If you are having trouble testing lower extremity reflexes, ask the patient to link their fingers, and pull outwards as you strike.

 

Above: If the above maneuver fails, have the patient clench their teeth as well. Ask if they have any unresovled dental problems first.

 

Next, move to the ankle reflex (S1 and S2). Slightly dorsiflex the foot by pulling up on the forefoot slightly, and strike the calcaneal tendon.

Above: Striking the achilles' tendon will cause the foot to plantarflex slightly. This reflex relies on the S1 and S2 nerve roots delivered via the sciatic nerve.