EXAMINATION OF REFLEXES

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Presented By: Farah Naaz M.D. Maolijat Ist Year

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SUPERFICIAL REFLEXES
Corneal

Reflex/Conjuctival Reflex Abdominal reflex Cremastric Reflex Bulbocavernous reflex

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CORNEAL REFLEX/conjuctival reflex

Pathway

Of Corneal Reflex

Afferent: Via The Ophthalmic Division Of The Trigeminal Nerve. Efferent: Via The Facial Nerve Supplying The Orbicularis Occuli Muscle. Center: Pons.
Normal

Response:Closure Of Te
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ABDOMINAL REFLEX
Segmental Normal

Innervation:T6-T12

Response:homolateral Contraction Of The Abdominal Muscles and retraction of the linea alba and the umbilicus towards the area stimulated.

Importance:

Absent Abdominal Reflexes:

1.

UMN Lesion On That Side.

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CREMASTRIC REFLEX
Segmental Normal

Innervation: L1-l2

Response:Pulling up of scrotum and testis on the side of the stimulus(due to contraction of the cremastric muscle)

Importance

Absent Cremastric Reflex:

1.

UMN Lesion On That Side.

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Bulbocavernous reflex
Segmental

Innervation:S1-S4

Normal

Response:Contraction Of Bulbocavernous Muscle Felt At The Junction Of The Penis And The Scrotum.

Importance:

Absent Reflex:

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Anal reflex
Segmental

innervation:s2-s4

Normal

response:Contraction of the external anal sphincter.

Importance

Absent reflex
1.

Pyramidal lesions.
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PLANTAR REFLEX
Segmental Normal

Innervation:S1

Response:Plantar Flexion Of The Foot And Toes. Response:

Abnormal

Most Important Component:Dorsiflexion Of Great Toe. Associated Components:Fanning Of Other Toes,Flexion Of Knee,Dorsiflexion Of Ankle,contraction of tensor fascia lata. 1/15/13

Importance of plantar reflex

Abnormal

plantar response is called extensor plantar or babinski sign present or positive. plantar response is the most important sign of UMN disease. of extensor plantar response apart from UMN disease: Infant below the age of one year. Comatose patients
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Extensor

Causes

1. 2.


1. 2. 3.

Absent plantar response:

Loss of sensations of the sole paralysis of the extensor hallucis. Lesion of the first sacral segment.

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Deep tendon reflexes

Biceps Triceps

reflex reflex reflex

Supinator/brachioradialis Knee Ankle

reflex reflex

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 1. 2. 3. 4. 5. . 1. 2. 3.

Exaggerated Tendon Reflexes: UMN Disease Tetnus Hysteria Fright Strychnine Poisoning Absent Tendon Reflexes: LMN Disease Neuronal Shock Normal Individuals Unable To Relax 1/15/13

Grading of reflexes
Grade Grade

0-Reflex Absent

1(+)-Elicitable Only On Reinforcement(sluggish Or Like Normal Ankle Jerk 2(++)-Brisk Or Like Normal Knee Jerk 3(+++)-Exaggerated 4(++++)-Presence Of Clonus
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Grade

Grade Grade

Biceps reflex
Segmental Position

Innervation:C5-C6

Of The Elbow:At Right Angle With Forearm Semipronated.

Examiner Taps His Own Finger Which Is Kept On The Patients Biceps Tendon.
Normal

Response:Contraction Of Biceps With Flexion Of Elbow.

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Triceps reflex
Segmental Position

Innervation:C6-C7

Of The Elbow:Keep The Forearm Of The Patient On His Own Trunk Loosely And Tap The Triceps Tendob(about 5cms Above The Elbow) Response:Contraction Of Triceps With Extension Of Elbow.

Normal

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Supinator reflex
Segmental Tap

Innervation:C5-C6

The Lower End Of Radius 5 Cms Above The Wrist Response:supination Of Forearm,flexion Of Elbow And Minimal Flexion Of Fingers.

Normal

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Knee reflex
Segmental Tap

Innervation:L2-L3

The Tendon Of Quadriceps Response:Extension Of

Normal

Knee.

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Ankle reflex
Segmental

Innervation:S1-S2

Tap

The Tendoachilles With Foot Dorsiflexed And Knee Minimally Flexed.

Normal

Response:Plantar Flexion Of Foot And Contraction Of Calf Muscles.

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Examination of reflexes

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