Athletic Training & Sports Medicine Center

AH 321

Neurology Reflex Laboratory

Test each of the following reflexes for three (3) your classmates and record.

Superficial Reflexes

Pathological Reflexes

Reflex	Negative or Positive Response
		L1	R1	L2	R2	L3	R3	L4	R4
Babinski’s
Chaddock’s
Oppenheim’s
Gordon’s
Piotrowski’s
Brudzinski’s
Hoffmann’s (digital)
Rossolimo’s
Schaeffer’s

Common Deep Tendon Reflexes
Reflex	Site of Stimulus	Normal Response	Pertinent Central Nervous System Segment
Jaw	Mandible	Mouth closes	Cranial nerve
Biceps	Biceps tendon	Biceps contraction	C5-C6
Brachioradialis	Brachioradialis tendon or just distal to the musculotendinous junction	Flexion of elbow and/or pronation of forearm	C5-C6
Triceps	Distal triceps tendon above the olecranon process	Elbow extension	C7-C8
Patella	Patellar tendon	Leg extension	L3-L4
Medial hamstring	Semimembranosus tendon	Knee flexion	L5,S1
Lateral hamstring	Biceps femoris tendon	Knee flexion	S1-S2
Tibialis posterior	Tibialis posterior tendon behind medial malleolus	Plantar flexion of foot with inversion	L4-L5
Achilles	Achilles tendon	Plantar flexion of foot	S1-S2

Superficial Reflexes
Reflex	Normal Response	Pertinent Central Nervous System Segment
Upper abdominal	Umbilicus moves up and toward area being stroked	T7-T9
Lower abdominal	Umbilicus moves down and toward area being stroked	T11-T12
Cremasteric	Scrotum elevates	T12, L1
Plantar	Flexion of toes	S1-S2
Gluteal	Skin tenses in gluteal area	L4-L5, S1-S3
Anal	Contraction of anal sphincter muscles	S2-S4

Pathological Reflexes
Reflex	Elicitation	Positive Response	Pathology
Babinski’s	Stroking of lateral aspect of side of foot	Extension of big toes and fanning of four small toes	Pyramidal tract lesion, organic hemiplegia
Chaddock’s	Stroking of lateral side of foot beneath lateral malleolus	Same response as above	Pyramidal tract lesion
Oppenheim’s	Stroking of anteromedial tibial surface	Same response as above	Pyramidal tract lesion
Gordon’s	Squeezing of calf muscles firmly	Same response as above	Pyramidal tract lesion
Piotrowski’s	Percussion of tibialis anterior	Dorsiflexion and supination of foot	Organic disease of central nervous system
Brudzinski’s	Passive flexion of one lower limb	Similar movement occurs in opposite limb	Meningitis
Hoffmann’s (digital)	"Flicking" of terminal phalanx of index, middle, or ring finger	Reflex flexion of distal phalanx of thumb and of distal phalanx of index or middle finger (whichever one was not "flicked")	Increased irritability of sensory nerves in tetany, pyramidal tract lesion
Rossolimo’s	Tapping of the plantar surface of toes	Plantar flexion of toes	Pyramidal tract lesion
Schaeffer’s	Pinching of Achilles tendon in middle third	Flexion of foot and toes	Organic hemiplegia

Neurology of Upper Extremity

Disc	Root	Reflex	Muscles	Sensation
C4-C5	C5	Biceps Reflex	Deltoid Biceps	Lateral arm Axillary nerve
C5-C6	C6	Brachioradialis Reflex (Biceps Reflex)	Wrist Extension Biceps	Lateral Forearm Musculocutaneous Nerve
C6-C7	C7	Triceps Reflex	Wrist Flexors Finger Extension Triceps	Middle Finger
C7-T1	C8	-----------------	Finger Flexion Hand Intrinsics	Medial Forearm Med. Antebrachial Cutaneous Nerve
T1-T2	T1	-----------------	Hand Intrinsics	Medial Arm Medial Brachial Cutaneous Nerve

Major Peripheral Nerve Testing

Nerve	Motor Test	Sensation Test
Radial Nerve	Wrist Extension Thumb Extension	Dorsal web Space between Thumb & Index Finger
Ulnar Nerve	Abduction-Little finger	Distal Ulnar Aspect-Little Finger
Median Nerve	Thumb Pinch Opposition of Thumb Abduction of Thumb	Distal Radial Aspect-Index Finger
Axillary Nerve	Deltoid	Lateral Arm-Deltoid patch on Upper Arm
Musculocutaneous Nerve	Biceps	Lateral Forearm

Neurology of Lower Extremity

Disc	Root	Reflex	Muscles	Sensation
T12-L1	L1	None	None	Back, over trochanter and groin
L1-L2	L2	None	Psoas, hip adductors	Back, front of thigh to knee
L2-L3	L3	Knee jerk sluggish, PKB positive, pain on full SLR	Psoas, quadriceps, thigh atrophy	Back, upper buttock, anterior thigh and knee, medial lower leg
L3-L4	L4	SLR limited neck flexion pain, weak or absent knee jerk, side flexion limited	Tibialis anterior, extensor hallucis	Medial buttock, lateral thigh, medial leg, dorsum of foot, big toe
L4-L5	L5	SLR limited one side, neck flexion painful, ankle decreased, crossed-leg raising-pain	Extensor hallucis, peroneals, gluteus medius, dorsiflexors, hamstring & calf atrophy	Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
L5-S1	S1	SLR limited, Achilles reflex weak or absent	Calf and hamstring, wasting of gluteals, peroneals, plantar flexors	Buttock, thigh, and leg posterior
	S2	SLR limited, Achilles reflex weak or absent	Calf and hamstring, wasting of gluteals, plantar flexors	Buttock, thigh, and leg posterior
	S3	None	None	Groin, medial thigh to knee
	S4	None	Bladder, rectum	Perineum, genitals, lower sacrum

Segmental Nerve Root Distributions

Segment	Key movements to test	Key sensory areas to test
C1-C4	Neck flexion	Head and face
C3	Neck lateral flexion	Lateral neck
C4	Shoulder elevation	Top of shoulder
C5	Shoulder abduction	Lateral arm & forearm
C6	Elbow flexion, wrist extension	Thumb & index finger
C7	Elbow extension, wrist flexion	Middle finger
C8	Ulnar deviation, thumb extension	Ring & small finger
T1	Approximation of fingers	Medial forearm
L1-L2	Hip flexion	Front of thigh
L3	Knee extension	Front of knee
L4	Ankle dorsiflexion	Medial leg
L5	Toe extension	Lateral leg
S1	Ankle plantar flexion	Sole of foot
S2	Knee flexion	Back of thigh