supported
REFLEX TESTING
Muscle Stretch Reflex | Myotatic Reflex (MSR’s) Patellar Quadriceps Slight contraction L2- L4
tendon of knee extensors
Femoral Nerve
AKA: Deep Tendon ➤ Between
Reflex (DTR’s) patella and tibial
tuberosity
Sitting with knee
Assessed by tapping flexed, foot
unsupported
over the muscle tendon
or over the PT’s finger Achilles Achilles tendon Slight contraction S1- S2
Tendon of plantarflexion
placed over the tendon ➤ Prone with foot Tibial Nerve
using a standard neuro at the end of the
plinth
hammer.
—------------------ NOTHING FOLLOWS —-----------------------
Procedure:
● Hammer Swinging
○ Hold handle loosely, dangling between thumb
and finger
○ Starting with an extended wrist, allow the
hammer to swing like a pendulum while flexing
the wrist until it reaches the tendon.
● Tap the tendon five or six times to uncover any fading
reflex response.
Response:
★ Brisk muscle contraction with visible joint movement
★ Strong, exaggerated movement with full movement of
extremities
★ Slight or sluggish movement
Grading:
0 Absent No visible or palpable muscle contraction
1+ Hyporeflexia Slight or sluggish muscle contraction with little or
no joint movement
2+ Normal Slight muscle contraction with slight movement
3+ Hyperreflexia Clearly visible, brisk ms. contraction with moderate
joint movement
4+ Abnormal Strong muscle contraction with 1-3 beats of clonus.
★ Reflex spread to contralateral side may be
noted
5+ Abnormal Strong muscle contraction with sustained clonus.
(sustained ★ Reflex spread to contralateral side may be
clonus) noted
MSR’s Stimulus Response CNS Segment
Brachioradialis Brachioradialis Slight contraction C5-C6
(Supinator tendon of elbow flexor,
Longus) slight wrist Radial Nerve
➤ Just distal to extension or
the radial
musculotendinou deviation
s junction or
radial tuberosity
Biceps Biceps tendon Slight contraction C5-C6
of elbow flexors
➤ Sitting with Musculocutaneous
arm flexed and Nerve
supported, PT’s
thumb over
biceps
Triceps Distal triceps Slight contraction C6- C7
tendon above of elbow
the olecranon extensors Radial Nerve
process
➤ Sitting with
REFLEX TESTING
Muscle Stretch Reflex | Myotatic Reflex (MSR’s) Patellar Quadriceps Slight contraction L2- L4
tendon of knee extensors
Femoral Nerve
AKA: Deep Tendon ➤ Between
Reflex (DTR’s) patella and tibial
tuberosity
Sitting with knee
Assessed by tapping flexed, foot
unsupported
over the muscle tendon
or over the PT’s finger Achilles Achilles tendon Slight contraction S1- S2
Tendon of plantarflexion
placed over the tendon ➤ Prone with foot Tibial Nerve
using a standard neuro at the end of the
plinth
hammer.
—------------------ NOTHING FOLLOWS —-----------------------
Procedure:
● Hammer Swinging
○ Hold handle loosely, dangling between thumb
and finger
○ Starting with an extended wrist, allow the
hammer to swing like a pendulum while flexing
the wrist until it reaches the tendon.
● Tap the tendon five or six times to uncover any fading
reflex response.
Response:
★ Brisk muscle contraction with visible joint movement
★ Strong, exaggerated movement with full movement of
extremities
★ Slight or sluggish movement
Grading:
0 Absent No visible or palpable muscle contraction
1+ Hyporeflexia Slight or sluggish muscle contraction with little or
no joint movement
2+ Normal Slight muscle contraction with slight movement
3+ Hyperreflexia Clearly visible, brisk ms. contraction with moderate
joint movement
4+ Abnormal Strong muscle contraction with 1-3 beats of clonus.
★ Reflex spread to contralateral side may be
noted
5+ Abnormal Strong muscle contraction with sustained clonus.
(sustained ★ Reflex spread to contralateral side may be
clonus) noted
MSR’s Stimulus Response CNS Segment
Brachioradialis Brachioradialis Slight contraction C5-C6
(Supinator tendon of elbow flexor,
Longus) slight wrist Radial Nerve
➤ Just distal to extension or
the radial
musculotendinou deviation
s junction or
radial tuberosity
Biceps Biceps tendon Slight contraction C5-C6
of elbow flexors
➤ Sitting with Musculocutaneous
arm flexed and Nerve
supported, PT’s
thumb over
biceps
Triceps Distal triceps Slight contraction C6- C7
tendon above of elbow
the olecranon extensors Radial Nerve
process
➤ Sitting with
