Upper Limb Deep Tendon Reflexes | Peripheral Neurological Examination

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This is not medical advice. The content is intended as educational content for health care professionals and students. If you are a patient, seek care of a health care professional. Deep tendon reflexes such as the biceps tendon or triceps tendon reflex can help you identify signs of radiculopathy during your peripheral neurological examination
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ARTICLES:
Lemeuniern et al. (2017): www.ncbi.nlm.nih.gov/pubmed/2...
Wainner et al. (2003): www.ncbi.nlm.nih.gov/pubmed/1...
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[@nourazaid5966]

Can’t imagine my studying without you , thank you dr

[@user-qs4pt5nj6e]

Crazy that pretty much everything that I need to know for my exam is on your youtube channel. Thanks!

[@bisoffi91]

Thank you guys. You are amazing 🤩

[@pamelakass2557]

You guys have the best videos. Thank you so much!!!

[@hagaremad5856]

Thank you Very helpful

[@abdulkarimalyousfi4266]

thankssss 🌷

[@meqatmakimohsenhameed4849]

Thanks dr

[@balancedbodypopt]

as always very helpful!

[@Physiotutors]

Happy to hear Naaz, thanks for subscribing!

[@-Solange-]

Is it possible to have sore muscles or tendons after this testing?

[@Johnconnollyefc]

I have been watching you for years. I am English but cannot say cervical radiculopathy in anything other than a dutch accent.

[@vasileiospetropoulos2046]

What about brachioradialis ?

[@Physiotutors]

It's an option for C5, C6 but less commonly used.

[@jagreetykhanal1474]

during the examination of bicep reflex why do we hit the reflex hammer on our finger?

[@Physiotutors]

Just easier to hit your own finger for the biceps tendon

[@smartmido8650]

Nice

[@Physiotutors]

Thanks

[@TheDivelDede]

Is it enough to test only one region to confirm that there is a wrong with upper limb reflexes?

[@Physiotutors]

You usually test all

[@stefanr00]

I usually don't use tendon reflexes as I feel it is not superior to comparing the resistance of Kenn muscles with the unaffected side. What is your take on this?

[@Physiotutors]

It's not about superior or inferior, because it's two different things and both are part of the neurological examination. If we can believe Wainner et al. (2003), then at least the biceps reflex has a moderate clinical value with LR+ of 4.9 when positive to indicate cervical radiculopathy, although not sure if they related it to a specific level. In their study it was the single best test to confirm CR. According to the author the biceps reflex is also reliable, but personally we sometimes struggle to elicit a reflex with different patients.

[@stefanr00]

I know that a reflex is different from a concious contraction because the impuls of a reflex does not involve the motor cortex. But both the impuls of a concious contraction and a reflex pass the nerve root. So why would the clinical presentation of a concious contraction and a reflex be different in any radiculopathy? I have been looking for an answer to this for quite some time, but I did not manage to find it yet.. Also, when practising reflex testing, I have found abnormalities (left to right differences) or struggled to get a normal reflex in asymptomatic classmates. This is why I think using reflex tests is unreliable.

[@Physiotutors]

Like your question! The difference (in our clinical reasoning) is that for a reflex to work we first need elongation of the muscle spindle, which will then create an afferent input at the alpha motor neuron (reflex arc), which leads to a motor response. These muscle spindles are innervated by myelinated nerve fibers with a large diameter (A alpha or IA, IB fibers) that first stop functioning in case they are in a hypoxic state, which occurs in case of a hernia which exerts pressure on the dorsal root. That's the theory, but agree with your last statement. Guess practice makes perfect!;)

[@stefanr00]

Physiotutors Thanks for your answer. Do you have a source where I can learn more about this theory?

[@Physiotutors]

You're welcome. Not really an article where we got this from. It's our reasoning based on physiology and neurology and what we have learned ourselves during our Masters. So maybe get in touch with an old neurology professor to explore this further...

[@ParamjeetKaur-bv1gc]

No reflex fr brachioradialis

[@Physiotutors]

It's an option, but honestly we find it hard to hit!

[@testobeidtest7473]

Came here for the reflexes. Stayed for that guy's body 🤤

[@samyakjain727]

you go to horny jail

[@demirdzaferovic2990]

*Bonk*