Deep Tendon Reflexes - A Definitive Guide

A review of the deep tendon reflexes (a.k.a. muscle stretch reflexes), including how to check and document them, and common etiologies of reflex abnormalities.
#reflexes #neurology #physicalexam #physicaldiagnosis

[@soenduldulao7457]

<a href="#" class="seekto" data-time="346">5:46</a> - Biceps <a href="#" class="seekto" data-time="388">6:28</a> Brachioradialis <a href="#" class="seekto" data-time="496">8:16</a> - Triceps <a href="#" class="seekto" data-time="565">9:25</a> - Patella <a href="#" class="seekto" data-time="613">10:13</a> - Ankle

[@AllezlesParisiens]

Cheers

[@StrongMed]

We aren't able to film at the med school at the moment, so we improvised a little.

[@sim_aware]

This was great! Thanks!

[@rumit9946]

Thank you to your wife for volunteering 😅

[@StrongMed]

@@rumit9946 I think she said this was the last time...

[@abhijitchatterjee7408]

Your videos on different topics are of great help to all. They are the best guides. Thanx.

[@cornelbacauanu1544]

This is the best explanation of Deep Tendon Reflexes I ever saw. This is the true art and science of Medicine. Thank you .

[@zuneid375]

I wanted to right exact the same thing

[@doctorjoy6686]

Thank you Dr. Eric. I can see how much effort you put in to explain each and every topic so clearly and with so many references. I have great respect for you. I'm a resident in internal medicine in Kashmir. We still use the notation on our patient files routinely here.

[@reyluna9859]

Love your videos Dr. Strong. I am a nurse practitioner student and they are very helpful. Keep up the good work.

[@stomecek]

It’s like you read my mind! I really needed this thank you for breaking it down.

[@hasanh.s5381]

Just came to say I love definitive guides.

[@EmmyZanoon]

The best teaching video I ever watched Thank you very much

[@Tremis77]

The metal at the end caught me off guard! Good taste. Very informative info on reflex testing as well.

[@Fxhealth]

Great as always Dr. Strong

[@Justice-101]

Thank you so much. You made it look very easy.

[@SKARTHIKSELVAN]

Thanks for putting efforts in making these useful videos.

[@user-lz1nh6dz2q]

This is best explanation I ever saw in my study Thanks soooooo match doctor You are such amazing ❤❤

[@gulsaquib961]

Thank you for this extremely helpful tutorial

[@khanabualamkhan4800]

Thank you dr eric for this very informative channel

[@ME-id7nz]

amazing as usual, thanks a lot doctor.

[@lorriemacierz3698]

Great video of all those I watched on DTR. Thank you.

[@xBassel92x]

Thank you very much Dr. Strong.

[@rehabkhalil8834]

Super helpful! Very clear examination and testing. Many thanks!

[@caalaaramadanofficial2037]

Thanks its excellent presentation

[@sitharabasheer]

Excellent demonstration .. thankyou very much Sir

[@zuneid375]

Best video on reflex ever

[@tokafarouk4923]

Thank you for this amazing video!

[@brettp_DO]

Great tips on eliciting the achilles reflexes from the supine position.. Almost all of my patients are supine on the ED cot, and I struggle to get a response from my patients often.

[@dipaksatapara4101]

Very informative sir. Thanks !

[@nickgowen7737]

Great job Dr. Strong. As usual, this video on reflex exam far exceeds any learning experience I had on reflexes (lecture, textbook, or other video). I find the most common problem with the reflex exam in my trainees is total absence of reflex exam. Absence of exam, in turn, is likely caused in large part by lack of adequate understanding of and confidence with the exam, which this video can correct. Also, I'm buying a Babinski hammer on your recommendation. I'll be interested to see if it improves my reflex exam skills and/or on the fly neurological exam teaching.

[@StrongMed]

Thanks for the kind words Dr. Gowen. I completely agree on the lack of reflex testing being associated with a lack of confidence - applies to much of the physical exam! I hope the Babinski turned out to be a good investment!

[@MedicalBroadcast]

Very informative. Thanks for sharing.

[@obiwan922]

excellent lecture!

[@arwarustom7623]

This is amazing!! Thank you

[@smittyjohn343]

Thank you Dr. Strong

[@nurefsan5977]

Thank you so much. I have an exam next week and this was actually so helpfull,💞

[@AhmedMohamed-dn4kk]

Highly recommended 👌

[@mickeysingh7443]

Thank you sir you are my role model

[@piyushchaudhary502]

Thank you so much Sir for Informational video🙏🙏

[@1Billi0naire]

Thanks Dr. Strong

[@ruili4634]

Thank you very much!

[@piotr5349]

Among students in Germany Trömner reflex hammer is very common. We also learn about tibialis posterior reflex (L5/S1) and Trömner reflex (C7/C8). Not sure if relevant in clinical practice. Definitely one of your coolest videos :)

[@StrongMed]

As an American non-neurologist, I've never seen either of those checked in practice, though I wouldn't infer that means they shouldn't be. I'm not familiar enough with them to have an opinion.

[@SavasMD]

@@StrongMed real educated men answer like this. nice man

[@waleedkhalid6908]

جزاك الله خيرا

[@theresecouture5903]

very helpful thank you rmt student have a great day.

[@entertainmentforyou9672]

Nice explain

[@sdharun1669]

Thank you for your wonderful explanation about reflexes sir you had given a complete understanding explanation sir....thank you so much sir...same way I am expecting all clinical methods to learn from you sir🙏🏽🙏🏽🙏🏽🙏🏽

[@user-wz5mj1gc6t]

this video is very helpful :) thanx

[@deepwithin6517]

Thank you so much 💕

[@killua9982]

Thank you very much

[@lavindubatugedara4796]

Thank you sir.❤

[@sokhengung7983]

The best Video

[@cynthiaserrano8078]

Thank you. So very helpful. Awesome video. Sorry I bought the Taylor hammer. LOL! But I got the Queen square now.

[@dailydoseofmedicinee]

When reflex responses are absent this could be a clue that the spinal cord, nerve root, peripheral nerve, or muscle has been damaged👍

[@user-yj6nb2xl3g]

amazing

[@drmalleshhnelajeri4522]

Thank you sir

[@FootballReins]

Start a series on CVS or Neurological system

[@vstpierre7]

I have very strong patellar reflexes. I get embarrassed as I usually kick the doc performing the test. I always have to apologise. Its like I'm taken over by Jackie Chan for a split second.

[@joodwaleed7570]

شكرا جزيلا

[@sudeeradeshan6042]

Thank you

[@amiinhaadi715]

Thanks Dr Eric I love you so much you really help me alot I love Aproach Series I appreciate From SOMALIA

[@dryarisow5782]

magacaga ka garty ina somalia thy ✌

[@amiinhaadi715]

Aaad iyo aaad yariisow

[@XoXoNurseKy]

What a great explanation! Thank you. What would you suggest using if none of the suggested options are available? For instance, I work in HEMS and have to elicit DTRs for my high risk OB transports. This is an extremely difficult environment to test DTRs, and reflex hammers and other devices like that are not readily stocked or available. Would the handle of shears work? Or some other easily available object?

[@StrongMed]

Wow, I haven't before had to consider eliciting reflexes in a helicopter before! Anything long with a relatively heavy striking end will work. I would think that shears would be better than either your fingertips or the head of a stethoscope, but I've never compared them. But give it a go, and let us know if it does the job!

[@XoXoNurseKy]

@@StrongMed thank you! I’ll give it a go!

[@fredastaire6156]

I am learning so much from these videos! Dr. Strong, do you have a Patreon page, by chance?

[@StrongMed]

I do: www.patreon.com/strongmedicine. Unfortunately, it's been dormant since COVID hit. With remote schooling my kids and helping to redesign our med school's curriculum to virtual format only, I had to free up bandwidth, and my Patreon was a casualty of that. With US COVID cases surging (with hosptial census now high), and kids still at home, I haven't been able to give it any attention.

[@musiqal333]

Oh no, I have the Taylor hammer only, and I'll be in emergency medicine rotations today. 🤦🏾‍♂️🤦🏾‍♂️🤦🏾‍♂️

[@unitelanka]

Great video as always. Is it true that hyperreflexia is suggestive of an upper motor neuron lesion and hyporeflexia is suggestive of a lower motor neuron lesion?

[@StrongMed]

Yes, that is a general principle. I chose not to explicitly state that in the video because I was trying to keep it relatively short and sufficiently discussing the difference between upper and lower motor neuron disease would add a few minutes to the runtime. It also feels a little like an oversimplification (e.g. acute stroke with hyporeflexia, ALS being an upper and lower motor neuron disease but usually causing only hyperreflexia) without a longer explanation of the exceptions.

[@lujain217]

The best ever

[@seanswann1143]

Thanks

[@ameenoahmad]

This man is subtly hilarious😂😂

[@PewPewFreedom]

Would you say that the L4 reflexes <a href="#" class="seekto" data-time="589">9:49</a> on her is considered a 3+?

[@sunving]

Thank you Dr Strong . Good lecture and I even know from you that distracting procedure named , I will get a new hammer.

[@tonysorice5142]

doc i just had a reflex test by a orthopedic doctor my kness didnt bump he hit me few times ,what do you think any never damage.i live ur video by the way ,,

[@NinjaSheepa]

Thanks m8

[@ikhlaqbright7579]

more videos also .... superficial reflexes and other neuro exams.....pls

[@StrongMed]

I was hoping to do a much longer video on the whole neuro exam, but my model (i.e. my wife) isn't super excited about being filmed. Also, filming an exam video in front of a green screen was not very satisfying. So I think I may need to defer the rest of the exam until I can safely film with standardized patients in our simulation center again - best case scenario, summer 2021. But we'll see...

[@andresdelavega]

nice new color grading

[@StrongMed]

Thanks! This was a particularly nice comment since the color grading was driving me crazy this time around, and I couldn't get myself satisfied with it. I usually film in front of a white screen and key it out, but with the white sheet on the exam table, it wasn't an option.

[@Abigail-hu5wf]

I personally prefer a Queen's Square or a Babinski because none of the others have necessary weight! But the more pointed hammers used by neurologists are doubtless more of use for them, because they need to precisely hit the exact part of the tendon they're aiming for. For a non-neuro like myself, larger heavy hammers are better! Harder to muck it up.

[@sabbo7069]

Sir, make a video of cranial nerve examination

[@korcommander]

I got my reflex hammer at home depot. It works great.

[@Mus-Doc]

Please list the name/brand/model of the telescoping hammer you're using. Thanks

[@StrongMed]

This is the hammer I was using in the video: www.amazon.com/Prestige-Babinski-Telescoping-Reflex-Hammer/dp/B00062N496 However, it has the same problem as discussed in the product reviews: loose hinge. I ended up superglueing it in position. I don't know how durable it is over the long-term, but I've also used this MDF hammer and found it much better (though >2x as expensive): www.amazon.com/MDF-Telescoping-Neurological-superficial-Free-Parts/dp/B00AZF36R4/ref=sr_1_4?dchild=1&keywords=mdf+babinski+hammer&qid=1605703265&s=industrial&sr=1-4

[@Mus-Doc]

@@StrongMed Thanks 👍. Keep up the great work

[@venkybly]

Tq

[@aydankamilova7099]

♥️♥️

[@waleedkhalid6908]

❤❤❤❤❤❤❤❤

[@allabout1783]

I wonder, what's stopping my Lecturers from teaching me like this

[@vgr112261]

Was the knee jerk on the video considered normal?

[@StrongMed]

Yes. There is a range of normal, and this person's knee jerk might be on the upper end of that range, but not in itself abnormal. If the patellar reflexes were asymmetric, that would be abnormal. Or if those were a person's patellar reflexes, but every other reflex was difficult to obtain, that also might suggest something worthy of further investigation.

[@preethamyadav8907]

Pls explain in detail history taking and case presentation of medicine long and short cases.

[@Mahadevan760]

With your eliciting the Brachioradialis reflex, the forearm is going into pronation, rather than supination !!!!!

[@Karoline_g]

I find when a patient can’t relax, it helps if I make it a joke and ask them to pretend to relax. Helps 60%+ of the time, IME. maybe it’s the distraction as you said. 🤷🏻‍♀️

[@TheDeepening718]

wtf I can't tingle to this.

[@LuvableAF]

My ankle reflex Grade is 0, so even walking takes 50% more effort than anyone else 😂😂

[@NadrianATRS]

Why aren't you wearing your glasses ?

[@StrongMed]

I had laser eye surgery 7-8 years ago that mostly corrected my farsightedness, but which induced some nearsightedness. So I now use glasses with reading and using screens, but not generally at other times.

[@colinsasso2753]

It's sad that educational videos (that are as good as this one) have 100x less views than the 8 yo putting hot sauce in his eyes for entertainment.

[@StrongMed]

Thanks for the sentiment! While more views are always nice (all things being equal), my target audience is probably much smaller than that of the 8 year old with hot sauce. So as long as people who will most benefit from my videos are the ones seeing them, I'd still consider 1% of the views a success!

[@TheReapr]

Dude seems very judgmental, nothing wrong with the Taylor hammer and no patient ever complains about being struck lightly in rapid succession..

[@StrongMed]

Judgmental? About a hammer? Really?

[@TheReapr]

@@StrongMed maybe judgmental is a strong word 😅

[@gamaltaher9714]

Thanks

[@TomJones-yl9zp]

Thanks

[@NEETmedicalGK]

Thanks