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Deep Tendon Reflexes (Stanford Medicine 25)

February 25, 2020


I’m now going to demonstrate the deep tendon reflexes and doing the reflexes is important to position the patient it’s important to know the level that you’re testing and it’s important to have the right tools in order to get the reflex we use a queen square hammer we give this to all our incoming interns I think it has a nice flex to it and is really good tool to get the reflex even though you can get it in other ways we recommend this I’m going to begin with the brachioradialis reflex I’m going to tap on the tendon not so much on the muscle and this is a C 5,6 reflex I’m also going to the biceps reflex by putting my hand on the biceps tendon and then I’m going to strike my thumb and I will feel the contraction as well as perhaps see the muscle contract I think one important caveat is that it’s important to keep your eye glued on the muscle and not so much focused on the movement because if it’s a very depressed reflex all you might see is a contraction of the muscle but that will a C 5, 6 again for the biceps on out of the triceps which you could do many ways if he’s relaxed this way I could just choose to leave his arm in the position it is and I’m actually getting a good reflex in this fashion show I probably wouldn’t proceed further but I could also suspend the arm like this instruct the patient to lean on my hand as though leaning on a on a railing and the measure of the hand being relaxed is that the forearm is loose and then once again strike the triceps tendon and this is a 6,7,8 reflex a higher level than the biceps 5,6. if people are a hyperreflexic you can often elicit a finger flexion reflex it’s only significant if it’s present on one side and not on the other the patient’s hand is very relaxed and it’s supported by his thigh I’m simply inserting my finger in there and asking him to just relax and leave his fingers the way they are I tap on my fingers and you can see the brisk movements of his fingers this is a finger flexion reflex that significance is only if it’s absent on one side and present on the other we’re going to do the brachioradialis reflex it’s important to tap on the tendon and not the muscle and to look at the muscle for contraction rather than looking for the movement so even though there’s a nice brisk movement you see the muscle contracting as well I’m then going to do the biceps reflex I put my hand on the biceps tendon and I tap on my thumb keep my eyes glued on the muscle both these reflexes the tricep the biceps and the brachioradialis are C 5,6 in the same position I can also do the triceps reflex as the patient is nicely relaxed I’m going to strike over the triceps tendon and look for the contraction of the triceps muscle and I see a contraction you might or might not see a movement of the arm the ankle reflex in a patient who is seated like this can be a little tricky and if it’s not a very brisk reflex you might conclude that it’s not there I would make sure that the foot is loose put a little bit of tension on the muscle but not too much and then strike over the Achilles tendon and I can both see a contraction and see the resultant movement this is S1 level this is a great example of how this hammer gives you a great advantage over a little tailor hammer I’m now going to move up to the knee reflex and again with the patient sitting like this and very relaxed it’s quite easy to hit the patellar tendon and notice a nice brisk contraction of the quadriceps muscle again be sure to expose the muscle you’re looking at keep your eyes glued on the muscle don’t worry about the movement especially the vastus medialis which is the last thing to go when you lose the knee reflex the ankle reflex in a bedridden patient there’s a little more tricky and there’s a couple ways you can do it but it’s easy to conclude that the reflex is not there when it actually is and your technique impeded you from getting it one way to do it is to simply make a bar with your two fingers across the the metatarsal heads and cock the foot up just a tad keep your eyes on the muscle and in this case you can actually see a nice brisk contraction just by this yet another way to do it is if the patient is mobile and has fairly loose joints you can outwardly rotate the hip flex the knee a tad again put a little bit of tension on the tendon keep your eye glued on the muscle don’t worry about the movement the muscle is what we want to see and we see a very nice contraction this is again S1 yet another way which is useful in someone who doesn’t relax very well is to take the foot you’re examining and cross the upper one third of the foot you’re testing over the lower one third of the other foot and the great beauty of this method is that if you get them positioned successfully the patient cannot keep their foot caught it winds up being a great position because they are unable to contract their foot and now I put a little bit of tension their eyes glued on the muscle and we see a very nice contraction this is the ankle reflex its S1 the preceding program is copyrighted by the Board of Trustees of the Leland Stanford junior University please visit us at med.stanford.edu

4 Comments

  • Reply Dav Bj February 3, 2020 at 2:37 pm

    I was waiting for the sledge hammer in the face this video is so boring

  • Reply ciao coso February 8, 2020 at 4:23 pm

    sono andato molto bene in tutto il test, ho fatto 0.200 nel pulsante e 0.166 nel suono (14 anni) e anche se sono andato malissimo nei colori mi sono divertito e mi sento più sicuro di me, grazie, bel video

  • Reply Muhammad Ali February 18, 2020 at 6:14 pm

    Knee jerk reflex seems fake 🙄

  • Reply DeepBlue February 19, 2020 at 10:52 pm

    Kendall?? (Big Time Rish)

  • Reply Steve's Channel February 21, 2020 at 6:54 am

    0:25 look into the patient's eyes, that's the look of a killer. I bet he has a navy suit for war

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