1. General considerations
2. Upper limb: supinatorbicepstricepsfingers
3. Lower limb: kneesanklesplantar
4. Increasing a reflex

General considerations

• Always compare one side to the other.
• Let hammer fall by gravity in most cases.
• Don't keep hammering a ptif can't elicit it.

Upper limb reflexes

Supinator/Brachioradialis (C5-6):

• Pt's elbow at 90°relaxed
• Hand pronated and resting on pelvis..
• Hammer falls on distal end of radius.

Biceps (C5-6):

• Pt's elbow still at 90°relaxed.
• Dr's finger over biceps tendon.
• Hammer falls on Dr's finger.

Triceps (C7-8):

• Pt's arm crossed overonto chest.
• Hammer swings into triceps tendon.

Fingers (C7-T1):

• Pt's hand palm upfingers very slightly flexed.
• Dr's finger pads overlie pt's finger pads.
• Hammer taps Dr's fingers.

Lower limb reflexes

Knees (L3-4):

• If supineDr. lifts both knees with 1 armflexing legs slightly.
• Hammer falls on patellar tendon..

Ankles (S1-2):

•  Need ankle and knee joints both now at 90° angleabducted and externallyrotated. 2 options of doing this:
  • Pt's lateral side of heel lies overtop opposite shin. Tell pt:"Place your heel on your opposite shin".
  • Alternativelypatient kneels on bedfeet dangle over edge of bed.
• Dr. grasps end of foot to maintain this position. Since Dr standing on Rside of ptDr's with L handhold pt's foot with R hand.
• Tap Achilles tendon.

Plantar (L5S1-2):

• Tell pt. what about to do.
• Use key to stroke from heelup lateral solethen medially across to ball offoot.
• See if big toe goes up (UMNL) instead of its normal down.
• Alternatively: try with a fingernail firstbefore the keyso less painto pt.
• See UMNLvs LMNL Reference.

Increasing a reflex

If can't elicit a reflexcan increase its visibility via any of 3 methods.

1. Clenching teeth.
2. Jendrassik's maneuver:
   • Pt clasps hands together tightly.
   • Pt. releases hands just before tap hammer.
3. Gripping an object.

Obviouslyteeth clenching is the only appropriate one while testing upperlimbs.

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