Deep Tendon Reflex: Key Tools and Techniques for Surgical Residents
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Deep Tendon Reflex: The Tools and Techniques. What Surgical Neurology Residents Should Know
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Ooi Lin-Wei, Leonard Leong Sang Xian, Vincent Tee Wei Shen, Chee Yong Chuan, Sanihah Abdul Halim, Abdul Rahman Izani Ghani, Zamzuri Idris, Jafri Malin Abdullah
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Deep Tendon Reflex: The Tools and Techniques. What Surgical Neurology Residents Should Know
Year: 2021 | Doi: 10.21315/mjms2021.28.2.5
Copyright (license): CC BY 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
The deep tendon reflex (DTR), also known as the myotatic reflex, is a critical aspect of neurological examinations. It involves an involuntary response that does not require cerebral input, allowing for the assessment of spinal cord integrity. Despite its importance, accurately interpreting DTR results can be challenging due to various influencing factors such as hammer force, strength and duration of contractions, and execution techniques. This paper addresses the history and evolution of reflex examinations, the mechanics of reflex arcs, and standard techniques for eliciting DTRs across different muscle groups.
Reflex Mechanics
One significant concept discussed in the paper is the reflex arc, which is composed of five key components: the receptor (muscle spindle), afferent fibre (Ia afferent nerve), integration center (located in the spinal cord), efferent fibre, and the effector (muscle). When a tendon is tapped, it stretches the muscle spindle, leading to the activation of Ia afferent fibres that transmit signals to the spinal cord. Here, these fibres synapse with alpha motoneurons, which activate the agonistic muscle, resulting in contraction, while simultaneously inhibiting the antagonistic muscle through inhibitory neurons. This intricate mechanism illustrates the reflexive action's reliance on both the peripheral and central nervous system, highlighting the importance of proper technique and understanding in eliciting and interpreting DTRs.
Conclusion
In conclusion, the deep tendon reflex plays a vital role in assessing neurological health and spinal cord function. The development and refinement of reflex hammers over the years have improved the efficacy and reliability of reflex testing. However, mastering the appropriate techniques and understanding the underlying physiology of DTRs is essential for clinicians, as accurate assessment and interpretation of reflex responses provide valuable insights into the nervous system's condition. Ultimately, a nuanced approach to reflex examination can enhance diagnostic accuracy and guide clinical decision-making.
FAQ section (important questions/answers):
What is the purpose of the deep tendon reflex test?
The deep tendon reflex test evaluates the integrity of the nervous system by eliciting involuntary muscle contractions in response to tendon taps. It can help identify abnormalities in nerve function, spinal cord health, or muscle response.
What factors affect the results of deep tendon reflexes?
Several factors can influence deep tendon reflex results, including the amount of force applied by the hammer, the technique used during testing, and individual physiological variations such as muscle stretch and nervous system thresholds.
How did the design of reflex hammers evolve over time?
The design of reflex hammers has evolved significantly since the 18th century, with various modifications in materials, weight, and ergonomic designs aimed at improving the efficacy and comfort of eliciting reflex responses during examinations.
What do exaggerated or diminished reflexes indicate in a patient?
Exaggerated reflexes typically suggest upper motor neuron disease, while diminished or absent reflexes indicate lower motor neuron disease. These findings, especially when asymmetrical, can provide critical insights into neurological health.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Deep Tendon Reflex: Key Tools and Techniques for Surgical Residents”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Table:
A table is a structured arrangement of data or information, often organized in rows and columns for easy reference and analysis. In medical contexts, tables can summarize various aspects of clinical studies, reflex examination results, or comparison of measurement scales, aiding healthcare professionals in decision-making and data review.
2) Roman (Roma):
Roman refers to anything related to ancient Rome. Its historical significance encompasses governance, law, architecture, and culture, influencing modern society. In the context of medicine, Roman practices in anatomical study and public health played foundational roles in developing healthcare systems and medical ethics, contributing to contemporary medical practices.
3) Disease:
A disease is a pathological condition of a bodily part or system resulting from various factors, including infection, genetic defects, or environmental influences. Understanding diseases is crucial in medicine for diagnosis and treatment. Reflex tests may indicate underlying diseases, emphasizing the importance of accurate assessments in clinical settings.
4) Surface:
Surface describes the external layer or boundary of an object, which is vital in anatomical studies. In clinical examinations, the surface may refer to skin or muscle layers involved in reflex actions. Accurate understanding of surface anatomies aids clinicians in performing examinations and diagnosing conditions based on reflex responses.
5) Queen:
The term 'Queen' may refer to authority and governance, symbolizing leadership. In medical contexts, it can relate to the 'Queen Square' reflex hammer, indicating a specific tool developed for neurological assessments. Such tools enhance clinical practice and the assessment of deep tendon reflexes, essential for diagnosing neuromuscular disorders.
6) Study (Studying):
A study is a systematic investigation into a subject or phenomenon, aimed at discovering new insights or confirming existing knowledge. In medicine, studies can range from clinical trials to observational research. They help develop and refine diagnostic tools, treatment protocols, and deepen the understanding of reflexes and their relevance in healthcare.
7) Activity:
Activity refers to the engagement in tasks or actions. In the medical context, 'activity' often relates to physical or neurological functions, including reflexive activities indicating neuronal integrity. Observing patient activity, especially in reflex testing, provides insight into functioning of the nervous system, informing diagnoses and treatment plans.
8) Hand:
The hand is an intricate limb composed of bones, muscles, and nerves, crucial for numerous functions like grasping and manipulating objects. In reflex testing, the hand's positions and movements are integral to eliciting and interpreting reflex responses. Thus, understanding hand anatomy enhances clinical assessment accuracy during neurological evaluations.
9) Medicine:
Medicine is the science and practice of diagnosing, treating, and preventing diseases. It encompasses a wide range of practices, including pharmacology and surgery. An understanding of reflex responses is critical in medical practice for assessing nervous system functionality and can inform effective treatment strategies for various medical conditions.
10) Reliability:
Reliability refers to the consistency and dependability of a measurement or assessment method. In medical contexts, the reliability of tests, including reflex evaluations, is paramount for accurate diagnosis. Reliable measures ensure that clinicians obtain consistent insights into patient health, aiding in effective treatment and management of medical conditions.
11) Quality:
Quality refers to the degree of excellence of something, often involving standards and specifications. In healthcare, quality denotes the overall effectiveness and precision of medical practices, interventions, or tools like reflex hammers. High-quality assessments lead to accurate diagnoses and successful patient outcomes, essential in improving healthcare systems.
12) Performance:
Performance relates to the execution or accomplishment of tasks or actions. In a medical setting, assessing the performance of reflexes helps evaluate neuromuscular function. Understanding performance metrics surrounding reflex actions helps clinicians identify abnormalities, enabling timely interventions for conditions affecting movement or coordination, enhancing patient care.
13) Observation:
Observation is the act of monitoring or examining phenomena, critical in medical assessments. In reflex testing, careful observation of responses directly informs diagnosis and treatment plans. It allows clinicians to gather qualitative data on patient reactions, reinforcing the importance of thorough assessment in understanding patient neurological health and conditions.
14) Training:
Training refers to the process of instructing individuals in a particular skill or field. In medicine, proper training in eliciting and interpreting reflexes is essential for healthcare providers to enhance diagnostic accuracy. Training includes familiarization with tools, techniques, and understanding underlying anatomy, which contributes significantly to clinical competence.
15) Company:
Company typically refers to a business entity. In healthcare, various companies produce medical equipment, including reflex hammers, impacting clinical practice. The quality and efficiency of such companies in providing reliable medical tools influence the effectiveness of healthcare delivery, demonstrating how corporate practices intersect with patient care and outcomes.
16) Lata:
Lata may refer to a specific term or context. However, its relevance in healthcare could be as a derivative of anatomical terms or specific medical terminology. Understanding such terms can enhance clarity in clinical discussions and documentation, contributing to effective communication among health professionals engaged in patient care.
17) Dali:
Dali may allude to Salvador Dalí, a Spanish artist known for surrealism. While not directly related to medicine, Dalí's contributions to visual arts reflect the intersection of creativity and observation crucial in healthcare. Artistic insights shaped innovative perspectives on human conditions, reminding healthcare practitioners of holistic aspects of patient experiences.
18) Sign:
A sign in medicine denotes a physical finding indicative of a health condition, observable during examination. Signs, such as reflex responses, flag neurological integrity or dysfunction, serving as critical indicators in diagnosing patients. Understanding signs is essential for clinicians to formulate accurate assessments and healthcare plans tailored to individual patient needs.
19) Wall:
Wall refers to a structural boundary; in medical contexts, it can represent anatomical walls (like those of the heart or abdomen) or the physical space of healthcare facilities. Observing anatomical walls assists in understanding bodily function and identifying pathological changes, crucial for developing effective medical interventions and guiding practice.
20) Inci (Imci):
An inch is a unit of measurement equal to 1/12 of a foot. In medicine, precise measurements are vital for assessing body dimensions, leveraging tools for physical examinations. Accurate measurements aid in evaluating reflexes, mobility, and overall health, informed by understanding human anatomy and physiological parameters critical for clinical practice.
21) Reflecting:
Reflecting refers to the act of considering or prompting thoughts. In neurological assessments, clinicians reflect on patients' responses during tests to interpret findings accurately. Reflection in clinical practice enhances understanding, ensuring healthcare professionals are cognizant of patient histories and conditions, which positively influences decision-making and treatment effectiveness.
22) Aristotle:
Aristotle, an ancient Greek philosopher, made significant contributions to various fields, including biology and philosophy. His systematic study of living organisms laid foundations for scientific inquiry, impacting the evolution of medical knowledge. Understanding Aristotle’s works informs healthcare practitioners about the historical context of biology and its relevance to current medical practices.
23) Knowledge:
Knowledge encompasses the awareness and understanding of information and concepts. In medicine, it is crucial for diagnosing and treating patients effectively, particularly regarding the nervous system and reflexes. Continuous learning and updating knowledge bases enhance clinical abilities and contribute to improved patient outcomes, emphasizing education's role in healthcare professionalism.
24) Education:
Education is the process of acquiring knowledge, skills, and competencies. In healthcare, ongoing education equips professionals with the latest developments, theories, and practices necessary for effective patient care. Continuous education ensures practitioners remain adept at interpreting diagnostic tests, including reflex assessments, thus contributing positively to patient health and corrective methodologies.
25) Relative:
Relative conveys a relationship or connection between entities. In medical contexts, it often describes comparative findings, such as the relative strength of reflex responses. Understanding these relationships helps clinicians evaluate patient conditions, monitor changes over time, and formulate appropriate treatment strategies based on correlated observations across different physiological metrics.
26) Hygiene (Hygienic):
Hygienic pertains to cleanliness and health-promoting practices. In medical settings, maintaining hygienic conditions is paramount to prevent infections and ensure patient safety. Understanding the significance of hygiene in clinical environments informs healthcare professionals about practices that promote patient well-being and reduces risks associated with medical procedures, particularly during physical examinations.
27) Buffalo (Buffaloes):
Buffalo may refer to a geographical location or historical context but holds no direct relevance to the medical field. However, if it signifies a medical institution or research center, it could highlight contributions to healthcare knowledge, underscoring how regional institutions play a role in advancing scientific inquiry and clinical practices.
28) Reason:
Reason signifies the ability to think, understand, and draw conclusions. In medicine, reasoning is vital for diagnosing conditions, interpreting reflex responses, and applying clinical knowledge effectively. Strong reasoning skills enable healthcare professionals to identify relationships between symptoms and underlying diseases, facilitating informed decisions that improve patient care outcomes.
29) Firing:
Firing refers to the rapid propagation of action potentials within neurons. In reflex pathways, effective firing of afferent and efferent neurons is essential for generating reflex actions. Understanding firing mechanics aids clinicians in interpreting reflex tests, providing deeper insights into neuromuscular health and the overall condition of the nervous system.
30) Seat (Seated):
Seated indicates a position of sitting which can influence physical examination outcomes. In reflex testing, maintaining proper seating may affect the ability to observe reflex responses accurately. Knowing optimal patient positioning techniques enhances medical assessments, ensuring clinicians provide effective and comfortable experiences while obtaining necessary diagnostic information.
31) Music:
Music refers to vocal or instrumental sounds combined to produce a harmonious effect. While not directly related to medical practice, music can play roles in patient care, influencing mood and relaxation. Understanding how music affects individuals is essential for creating supportive healthcare environments, emphasizing holistic treatment in medical approaches.
32) Ivory:
Ivory, the hard white material from the tusks of animals, may not directly relate to modern medical practice. However, in the historical context, ivory has been used in medical instruments. Understanding historical uses of such materials informs clinicians about advancements in medical technology and ethical considerations of sourcing medical tools.
33) Cloud:
Cloud typically refers to a visible mass of condensed water vapor in the atmosphere but may symbolize hurdles in clarity of understanding in clinical assessments. The concept could imply challenges such as uncertainties in diagnosis or interpretation of reflex tests, underlining the importance of clear protocols and knowledge in clinical practice.
34) Rules:
Rules are established principles or guidelines aimed at governing behavior or procedures. In medicine, adherence to rules ensures consistent practice, particularly during diagnostic and therapeutic processes. Understanding and applying rules related to clinical assessments and reflex testing contribute to reliable results, fostering patient safety and effective care outcomes.
35) Camel:
Camel, a domesticated animal commonly found in desert regions, does not have significant direct relevance to medical practices today. However, it can symbolize adaptations in physiology, useful for understanding comparative anatomy in clinical studies. Understanding different species can enhance insights into human biology and conditions, promoting broader medical knowledge.
36) Shila (Sila):
Sila does not hold explicit relevance in the medical or scientific context as discussed, but could be a specific term or reference pertinent to a local culture or practice. Clarifying such terms enhances understanding across cultural contexts in healthcare, promoting sensitivity in patient interactions and improving overall care quality.
37) Pari:
Pari, while ambiguous in meaning, may relate to specific terms or vernacular that lacks broad applicability in medicine. However, understanding the connotations associated with specific terms can greatly enhance clinician-patient communication, vital for effective diagnostic and therapeutic interactions and overall quality of care.
38) Wine:
Wine, an alcoholic beverage made from fermented grapes, has historic significance in numerous cultures. In medical discussions, the consumption of wine and its effects on health may come into play, particularly related to its impact on neurological assessments. Understanding its effects informs clinicians regarding patient lifestyle factors relevant to overall health.
39) Hair:
Hair typically refers to the strands growing from the skin of mammals, which can have cosmetic, cultural, and biological implications. In medical contexts, hair may be indicative of systemic health issues. Analyzing conditions relating to hair can provide insights into nutritional or dermatological health, informing clinicians on patient assessments.
40) Bell:
A bell often serves as a signal or alert in various contexts. In medicine, concepts from the term bell could relate to signals or notifications necessary during clinical assessments. Understanding and utilizing symbolic references within clinical practice improves communication efficiency among healthcare professionals, enhancing patient-centered care effectiveness.
41) Horn:
Horn, a hard structure composed of keratin, is found in many animals. In medical assessment contexts, horn structures may refer to anatomical formations relevant to physical examinations. Understanding horn-like structures enhances knowledge about anatomical variations, informing healthcare professionals about potential implications for diagnostics relating to patient conditions.
42) Pain:
Pain is a sensory and emotional experience related to actual or potential tissue damage. It's a fundamental symptom that drives medical assessments and treatment strategies. Understanding pain mechanisms is crucial in clinical practice, particularly in interpreting reflex responses, which significantly inform clinical approaches to patient care and management strategies.
43) Post:
Post generally refers to a position following an event. In medical contexts, 'post' can indicate post-operative conditions or recovery phases. Understanding the post-phase dynamics of reflex tests is vital in tailoring rehabilitation plans, illustrating the importance of ongoing assessments after surgical interventions to monitor recovery and functional outcomes.
Other Health Sciences Concepts:
Discover the significance of concepts within the article: ‘Deep Tendon Reflex: Key Tools and Techniques for Surgical Residents’. Further sources in the context of Health Sciences might help you critically compare this page with similair documents:
Nervous system, Spinal Cord, Flexor tendon, Upper extremities, Lower extremities, Neurological examination, Reflex arc, Supine Position, Deep tendon reflexes, Median nerve, Upper motor neuron, Lower motor neuron, Hyperreflexia, Musculocutaneous nerve, Muscle group, Achilles tendon, Prone position, Relaxation time, Deep tendon reflex, Extensor surfaces, Palmar surface, Axillary nerve, Ulnar nerve, Nervous Disease, Spinal nerve root, Myotatic reflex, Muscle spindle, Peripheral nerve, Biceps reflex, Brachioradialis reflex, Knee jerk, Achilles reflex, Neural pathway, Lower motor neuron disease, Knee flexion, Afferent fibre, Agonist muscles, Antagonistic muscle, Reflex activity, Technique, Patellar tendon, Ankle jerk, Xiphoid process, Triceps reflex, Radial nerve, Dorsal scapular nerve, Hyporeflexia, Specific stimulus, Biceps muscle, Triceps muscle, Latissimus dorsi muscle, Biceps tendon, Triceps tendon, Extension of the elbow, Reflex response, Muscle stretch reflex, Brachioradialis tendon, Myotome.