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There are five deep tendon reflexes and a number of superficial and visceral reflexes covered here. The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions.
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.
This article will focus on the “deep tendon reflexes” which are more appropriately named — and will be referred to herein — as muscle stretch reflexes (MSR). MSR grading is based on a clinician’s subjective evaluation of amplitude, with a wide range of what can be normal.
Deep Tendon Reflexes (DTRs) are involuntary, automatic responses to a stimulus applied to a tendon, typically involving the muscle it is connected to. These reflexes are essential for assessing the integrity of the nervous system, particularly the motor and sensory pathways.
Deep tendon reflexes or, more accurately, the 'muscle stretch reflex' can aid in evaluating neurologic disease affecting afferent nerves, spinal cord synaptic connections, motor nerves, and descending motor pathways.
Grading Deep Tendon Reflexes. Reflexes are involuntary contractions of muscles in response to a stimulus and are classified as deep tendon, superficial, or pathologic (Hinkle, 2021). The most common reflexes tested are the deep tendon reflexes which include the biceps, triceps, brachioradialis, quadriceps (patellar), and Achilles (ankle).
Healthcare providers use the deep tendon reflex (DTR) examination to check for hyperreflexia as part of a neurological exam. The best-known of the reflexes is the patellar, or knee-jerk, reflex. The DTR exam involves a healthcare provider tapping your knee with a rubber hammer (it shouldn’t hurt).
Deep tendon reflexes include the patellar, biceps, triceps, and brachioradialis reflex. They are an important indicator of intact peripheral nerves and spinal cord. Tests are done in routine neurological examinations, and to investigate neurological symptoms or monitor disease progressions.
GRADING SCALE. There are a number of accepted scales for grading deep tendon reflexes. The scale used at WSCC clinics is the National Institute of Neurological Disorders and Stroke (NINDS 1991) muscle stretch reflex scale. The reflex is graded based on the amplitude of the response.
Deep tendon reflexes. Deep tendon (muscle stretch) reflex testing evaluates afferent nerves, synaptic connections within the spinal cord, motor nerves, and descending motor pathways.