a3daexamination of Reflexes

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1/15/13

EXAMINATION OFREFLEXES

Presented By:

Farah Naaz

M.D. Maolijat

Ist Year



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SUPERFICIAL

REFLEXESCornealReflex/Conjuctival

Reflex

Abdominal reflex

Cremastric Reflex

Bulbocavernous reflex



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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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Segmental Innervation:T6-T12

Normal 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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Segmental Innervation: L1-l2

Normal 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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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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Segmental innervation:s2-s4

Normal response:Contraction of theexternal anal sphincter.

Importance :

Absent reflex

1.

Pyramidal lesions.



Segmental Innervation:S1

Normal Response:Plantar Flexion Of The

Foot And Toes.

Abnormal Response:

Most Important Component:Dorsiflexion

Of Great Toe.

Associated Components:Fanning Of Other

Toes,Flexion Of Knee,Dorsiflexion

Of Ankle,contraction of tensor fascia lata.



Abnormal plantar response is called

extensor plantar or babinski sign

present or positive.

Extensor plantar response is the

most important sign of UMN disease.

Causes of extensor plantar response

apart from UMN disease:

1. Infant below the age of one year.

2. Comatose patients



Absent plantar response:

1. Loss of sensations of the sole

2. paralysis of the extensor hallucis.

3. Lesion of the first sacral segment.



Biceps reflex

Triceps reflex

Supinator/brachioradialis reflex

Knee reflex

Ankle reflex



Exaggerated Tendon Reflexes:

1. UMN Disease

2. Tetnus

3. Hysteria

4. Fright

5. Strychnine Poisoning

.

Absent Tendon Reflexes:

1. LMN Disease

2. Neuronal Shock

3. Normal Individuals Unable To Relax



Grade ‘0’-Reflex Absent

Grade ‘1’(+)-Elicitable Only On

Reinforcement(sluggish Or Like

Normal Ankle Jerk

Grade ‘2’(++)-Brisk Or Like Normal

Knee Jerk

Grade ‘3’(+++)-Exaggerated

Grade ‘4’(++++)-Presence Of Clonus



Segmental Innervation:C5-C6

Position Of The Elbow:At Right Angle

With Forearm Semipronated.

Examiner Taps His Own Finger Which

Is Kept On The Patient’s Biceps

Tendon.

Normal Response:Contraction Of

Biceps With Flexion Of Elbow.




Position Of The Elbow:Keep The

Forearm Of The Patient On His Own

Trunk Loosely And Tap The Triceps

Tendob(about 5cms Above The

Elbow)

Normal Response:Contraction Of

Triceps With Extension Of Elbow.




Tap The Lower End Of Radius 5 Cms

Above The Wrist

Normal Response:supination Of

Forearm,flexion Of Elbow And

Minimal Flexion Of Fingers.



Segmental Innervation:L2-L3

Tap The Tendon Of Quadriceps

Normal Response:Extension Of Knee.



Segmental Innervation:S1-S2

Tap The Tendoachilles With FootDorsiflexed And Knee Minimally

Flexed.

Normal Response:Plantar Flexion Of

Foot And Contraction Of Calf

Muscles.



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a3daexamination of Reflexes