Record reflexes as "2+" if vigorous, "1+" if present but weak, "0" if not present. "3+" indicates hyperreflexia, 4+ indicates hyperactivity with clonus.
|Patellar:||[method 1]: With legs dangling, feel for the bottom of the patella (knee cap), and feel the tendon in the groove before the head of the tibia. Place one hand on the thigh right above the patella. Stand off to the side, and hit the tendon using the other hand. You will feel the muscle contract, and you will see the leg extend. If no response, have the patient try to pull his hands apart.|
[If patient is bedridden]:Cross the leg to be tested over the other leg, at the level of the knees. Place your hand on the quadriceps muscle (anterior thigh) just above the knee, and strike the tendon. You should feel the muscle contract, even though the leg is already extended.
|Achilles:||Gently hold the foot at about 90 degrees to the leg - do not apply much pressure or dorsiflex very high. Tap the tendon at about the height of the malleoli. The foot should plantarflex slightly - you can feel it in the hand that is holding the foot.|
|Plantar:||Take a fairly sharp instrument (the handle of the reflex hammer is fine) and, pushing fairly firmly, trace a line along the lateral aspect of the bottom of the foot, then along the ball of the foot (from little toe to big toe). Watch the big toe - if it goes up, you can write "Babinski sign present." Otherwise, you can write "downgoing plantar reflex."|
|Bicep:||Have the patient rest their forearm on their lap, with palm up. Feel for the biceps tendon in the elbow joint (antecubital fossa) - it's about dead center in that space. Push on the tendon with your thumb, and make sure it's not tense - if it is, get the patient to relax it. Hit your thumbnail with the hammer. You can feel the biceps respond under your thumb - you may see some flexion of the arm, as well.|
|Tricep:||[method 1]: Hold the arm up by the elbow, with the forearm dangling (the patient will look like a scarecrow). Shake the forearm gently to get the patient to relax it. The triceps tendon runs off of the olecranon - you want to strike it between the olecranon and the humerus. The arm will extend.|
[method 2]:With the patient resting his arm in his lap, place one hand on the tricep muscle and strike the tendon with the hammer - you can feel the muscle contract in response.
|Brachioradialis:||About 5 centimeters from the wrist joint, along the radius, the wrist extensor tendons are beneath the thumb extensor muscles. Hold the patient's wrist with the thumb up, and using the flat of the hammer, strike the radius over these thumb extensors. The wrist will extend slightly.|