Reflexes

DEEP TENDON REFLEXES The deep tendon reflexes (DTRs) (lable^i.S.-.S) can be pathologic by being asymmetric, absent, or hyperactive. Hyperactivity is generally associated with upper motor neuron dysfunction and is manifested by clonus, i.e., repetitive jerking of the reflex, or by pathologic spread, i.e., muscles that are innervated by adjacent motor nerve roots contract. Examples of pathologic spread are adductor spread when eliciting a knee jerk or finding a positive Hoffmann reflex, with the thumb flexing on flicking the tip of the middle finger. Hypoactive reflexes in the lower extremities can be recruited by the Jendrassik maneuver: locking the finger tips together and pulling. This maneuver decreases the inhibition of the reflex arc by internuncial neurons within the spinal cord. The major value of the maneuver lies in assisting in determining whether a weak reflex is present or not. Finding abnormality in DTRs can help in the assessment of spinal cord lesions, radicular lesions, and peripheral nerve lesions.

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