Deep Tendon Reflex Assessment

1. Identify the patient
2. Explain the procedure
3. Bicep Reflex:
   • Flex the patient’s arm at the elbow and rest his forearm on his thigh with the palm up.
   • Place the thumb firmly on the biceps tendon in the antecubital fossa.
   • Strike the thumb with the hammer.
   • The forearm will flex at the elbow, and the biceps muscle should contract.
4. Triceps Reflex:
   • Lift the patient’s (relaxed) arm to the side (hold at the elbow), facing downward at (normally) a 90 degree angle.
   • Strike the olecranon (where the triceps tendon insertion is located).
   • Extension of the arm should be noted.
5. Brachioradialis Reflex:
   • Support the arm. Identify the brachioradialis tendon at the wrist. It inserts at the base of the styloid process of the radius, usually about 1 cm lateral to the radical artery.
   • Place the thumb of the hand on the biceps tendon while tapping the brachioradialis tendon with the other hand.
     • Brachioradialis reflex: flexion and supination of the forearm
     • Biceps reflex: flexion of the forearm
     • Finger jerk: flexion of the fingers.
6. Patellar Reflex (Knee Jerk): with the knees hanging, place one hand on the quadriceps to feel contraction.
   • If in bed, slightly flex the knee by placing your forearm under both knees by contraction of the quadriceps with extension of the lower leg.
   • Note for hyperreflexia (INC)
   • Use the Jendrassik maneuver if no response is noted.
7. Achilles Reflex (Ankle Jerk): have the patient sit, place one hand under the sole and dorsiflex the foot slightly. Tap on the Achilles tendon just above its insertion on the calcaneus.
   • If no response is found, have the client kneel on a chair with the knee facing the back of the chair, with the feet protruding. Tap on the tendon, and note a slight dorsiflexion.
   • Use the Jendrassik maneuver if no response is noted.
8. Documentation