Rodriguez-Beato Freddie Y., De Jesus Orlando
University of Puerto Rico, Medical Sciences Campus, Neurosurgery Section
First described in 1875 by Wilhelm Heinrich Erb and Carl Friedrich Otto Westphal, the deep tendon reflex (DTR) is essential in examining and diagnosing neurologic disease. Deep tendon reflexes or, more accurately, the 'muscle stretch reflex' can aid in evaluating neurologic disease affecting afferent nerves, spinal cord synaptic connections, motor nerves, and descending motor pathways. Proper technique and interpretation of results are crucial in achieving a proper distinction between upper and lower motor neuron pathologic processes such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), spinal cord injuries, and spinal muscular atrophies, with the presence of hyporeflexia or hyperreflexia considered a 'hard sign' of neurologic dysfunction. There are five primary deep tendon reflexes: biceps, brachioradialis, triceps, patellar, and ankle. Muscle involved: biceps brachii. Nerve supply: musculocutaneous. Segmental innervation: C5-C6. Muscle involved: brachioradialis. Nerve supply: radial. Segmental innervation: C5-C6. Muscle involved: triceps brachii. Nerve supply: radial . Segmental innervation: C7-C8. Muscle involved: quadriceps femoris. Nerve supply: femoral. Segmental innervation: L2-L4. Muscles involved: gastrocnemius, soleus. Nerve supply: tibial. Segmental innervation: S1-S2. To provide a standard scale for evaluating deep tendon reflexes, in 1993, the National Institute of Neurological Disorders and Stroke (NINDS) proposed a grading scale from 0 to 4. This scale has been validated and is universally accepted. NINDS grading of deep tendon reflexes. 0: Reflex absent. 1: Reflex small, less than normal, includes a trace response or a response brought out only with reinforcement. 2: Reflex in the lower half of a normal range. 3: Reflex in the upper half of a normal range. 4: Reflex enhanced, more than normal, includes clonus if present, which optionally can be noted in an added verbal description of the reflex. In some instances, a plus sign (+) is written after the number. When discussing DTRs, adding or omitting a plus sign does not change the meaning of the reflex grade observed. What is 'normal' typically depends on the patient's history and past documented reflex grade. Abnormality is suggested when asymmetric reflexes are found. Once the examiner obtains a reflex on one side, they should test the same reflex on the opposite side for comparison.
深腱反射（DTR）于1875年由威廉·海因里希·厄布和卡尔·弗里德里希·奥托·韦斯特法尔首次描述，在神经系统疾病的检查和诊断中至关重要。深腱反射，或者更准确地说，“肌肉牵张反射”，有助于评估影响传入神经、脊髓突触连接、运动神经和下行运动通路的神经系统疾病。正确的检查技术和结果解读对于正确区分上、下运动神经元病理过程（如多发性硬化症（MS）、肌萎缩侧索硬化症（ALS）、脊髓损伤和脊髓性肌萎缩）至关重要，反射减弱或亢进被视为神经功能障碍的“硬指标”。有五种主要的深腱反射：肱二头肌反射、肱桡肌反射、肱三头肌反射、髌反射和踝反射。涉及的肌肉：肱二头肌。神经供应：肌皮神经。节段性支配：C5 - C6。涉及的肌肉：肱桡肌。神经供应：桡神经。节段性支配：C5 - C6。涉及的肌肉：肱三头肌。神经供应：桡神经。节段性支配：C7 - C8。涉及的肌肉：股四头肌。神经供应：股神经。节段性支配：L2 - L4。涉及的肌肉：腓肠肌、比目鱼肌。神经供应：胫神经。节段性支配：S1 - S2。为了提供评估深腱反射的标准量表，1993年，美国国立神经疾病和中风研究所（NINDS）提出了一个从0到4的分级量表。该量表已经过验证并被普遍接受。NINDS深腱反射分级。0：反射消失。1：反射微弱，低于正常，包括微量反应或仅通过加强刺激引出的反应。2：反射在正常范围的下半部分。3：反射在正常范围的上半部分。4：反射增强，高于正常，如有阵挛也包括在内，阵挛可在对反射的补充文字描述中注明。在某些情况下，数字后面会写一个加号（+）。在讨论深腱反射时，添加或省略加号不会改变所观察到的反射分级的含义。“正常”通常取决于患者的病史和过去记录的反射分级。当发现反射不对称时提示异常。检查者在一侧引出反射后，应在对侧测试相同的反射进行比较。
