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MSK Neuro Exam - Reflexes - Coggle Diagram
MSK Neuro Exam - Reflexes
Lumbar spine neuro Ax.
Upper limb neuro Ax.
Why?
Help to identify if there s a comprise in the patients neurological system and if so at what spinal level this is at.
Knee Jerk
Hit between tibial tuberosity and distal patella (patella tendon).
Position: sat with legs hanging off bed.
Spinal level L 3,4.
Remember form toe to head:
S 1, 2 (ankle)
L 3, 4 (knee)
C 5, 6 (Biceps)
C 7, 8 (Triceps)
Babinski
Position: supine on plinth.
Positive = extension of big toe + splaying of toes.
Testing for the presence of an upper motor neuron legion.
Sharp point at calcaneus, along lateral and across metatarsal phalangeal heads (Out and in).
Ankle Jerk
Position: sat with legs hanging off bed.
Posterior to lateral malleolus (Achilles tendon).
Spinal level S 1,2.
Clonus
Position: supine on plinth.
Sharp and sudden jerk into dorsi flexion. Ensure to check ROM and pain first.
Testing for the presence of an upper motor neuron legion.
Positive = 3 or more rhymical contractions into plantar flexion.
Brachioradilais
Position: sat on edge of bed, rest pt arm on my forearm.
Spinal level C 6,7.
Radial styloid and come one thumb width proximally.
Biceps
Position: sat on edge of bed, rest pt arm on my forearm, thumb on tendon.
End of distal tendon of bicep.
Spinal level C 5,6.
Triceps
Position: sat on edge of bed, rest pt arm on my forearm.
One thumb width proximal to olecranon.
Spinal level C 7,8.
Hoffman's
Flick distal index interphalgeal.
Positive = pinching motion of thumb and index finger.
Testing for the presence of an upper motor neuron legion.
Sens (59%), Spec (49%).
Consider Babinski and clonus...
Present signs that may indicate upper motor neuron lesion such as gait disturbance.