From the Guidelines
Evaluating deep tendon reflexes (DTR) as part of a neurological examination is crucial for assessing the integrity of the central and peripheral nervous systems, particularly the spinal cord, brainstem, and peripheral nerves.
Key Points
- The primary point of evaluating these reflexes is to identify any abnormalities that may indicate neurological disorders, such as upper motor neuron lesions, spinal cord injuries, or peripheral neuropathies 1.
- By assessing DTR, healthcare providers can gather valuable information about muscle tone, reflex arc integrity, and the presence of any pathological reflexes, which can inform diagnosis, treatment, and management of various neurological conditions.
- Diminution or absence of deep tendon reflexes can occur with lower motor neuron disorders, whereas increased reflexes and an abnormal plantar reflex can be signs of upper motor neuron dysfunction 1.
- A comprehensive neuromotor examination, including the evaluation of DTR, should also assess passive and active muscle tone, primitive reflexes, sensory status, and quality of gross motor skills 1.
- Healthcare providers should be aware of the importance of evaluating DTR in various patient populations, including children, to identify potential neuromotor dysfunction and provide appropriate interventions.
From the Research
Purpose of Evaluating Deep Tendon Reflexes
The purpose of evaluating deep tendon reflexes (DTR) as part of a neurological examination is to:
- Assess the nervous system, with depressed and hyperactive DTRs suggesting peripheral and central nervous system compromise, respectively 2
- Provide an objective indicator for lumbar spine disorders, which can be assessed even in patients with impaired consciousness or cognition 3
- Act as "hard" signs in situations where clinical assessment is complicated by patient anxiety, and become more useful as clinical experience develops 4
Key Aspects of DTR Evaluation
Key aspects of DTR evaluation include:
- Quantifying the tendon tap used by clinicians to elicit DTRs and the reflex response elicited 2
- Assessing the patellar tendon reflex (PTR), Achilles tendon reflex (ATR), pathological reflexes (Babinski reflex), and reflex enhancement (Jendrassik maneuver) 3
- Determining left-right differences, differences between the upper and lower extremities, and the overall balance of the limb to determine whether an increase or decrease in DTR is pathological 3
Clinical Applications
DTR evaluation has clinical applications in:
- Diagnosing lumbar spine diseases, including determining the level of lumbosacral nerve root disorder and assessing the presence of a lumbosacral transitional vertebra, nerve root malformation, or furcal nerve 3
- Assessing patients with various neurological abnormalities, including trigeminal pain and neuralgia, facial neuropathy, and brainstem and hemispherical lesions 5