Fundamental Concepts in the Diagnosis of Low Back Pain
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
With the patient seated, test the deep tendon reflexes of the lower and upper extremities. These include the following: Biceps reflex: (C5)Triceps reflex: (C7)Patellar reflex: (L4)Hamstring reflex: (L5)Achilles tendon reflex: (S1)
Diagnosis in Orthopaedics
Louis Solomon, David Warwick, Selvadurai Nayagam in Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
A deep tendon reflex is elicited by rapidly stretching the tendon near its insertion. A sharp tap with the tendon hammer does this well; but all too often this is performed with a flourish and with such force that the finer gradations of response are missed. It is better to employ a series of taps, starting with the most forceful and reducing the force with each successive tap until there is no response. Comparing the two sides in this way, we can pick up fine differences showing that a reflex is ‘diminished’ rather than ‘absent’. In the upper limb we test biceps, triceps and brachioradialis; and in the lower limb the patellar ligament and Achilles tendon.
Diagnosis in orthopaedics
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
A deep tendon reflex is elicited by rapidly stretching the tendon near its insertion. A sharp tap with the tendon hammer does this well; but all too often this is performed with a flourish and with such force that the finer gradations of response are missed. It is better to employ a series of taps, starting with the most forceful and reducing the force with each successive tap until there is no response. Comparing the two sides in this way, we can pick up fine differences showing that a reflex is ‘diminished’ rather than ‘absent’. In the upper limb we test biceps, triceps and brachioradialis; and in the lower limb the patellar and Achilles tendons.
An exon 5 mutation (c.425G>C, p.Gly141Ala) in the SOD1 gene in a Chinese family associated with incomplete penetrance
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2020
Si-Qi Dong, Xiao-Ni Liu, Wen-Bo Yang, Yan-Ni Zhou, Jiu-Cun Wang, Xiang-Jun Chen
The proband’s cousin (III-11), 46-year-old female, complained a four-year history of weakness in both lower limbs, one year of weakness in the right great thenar, and half a year of hoarseness. Physical examination showed normal muscle strength except for 4/5 of grip force of the right hand and 4/5 of muscles of bilateral lower limbs. Brisk deep tendon reflex was detected in the right upper limb. Palmomental reflex was positive bilaterally. Babinski’s and Chaddock’s signs were present on the left side. NCV/EMG showed the following: normal motor and sensory conduction velocity except decreased conduction velocity in the distal right median nerve; reduced peroneal and tibialis motor compound motor action potentials; fibrillations or positive sharp waves in muscles of the lower extremities and T8 paraspinal muscle; large motor units and reduced recruitment in muscles of the upper and lower extremities, rectus abdominis, T8 paraspinal muscle, trapezius, and lingualis.
Dry needling equilibration theory: A mechanistic explanation for enhancing sensorimotor function in individuals with chronic ankle instability
Published in Physiotherapy Theory and Practice, 2021
Jennifer F. Mullins, Arthur J. Nitz, Matthew C. Hoch
Muscle spindles can detect changes in static and dynamic muscle length through the gamma motor neuron. As a muscle shortens, the gamma motor neuron increases its firing rate to maintain an appropriate calibration with the extrafusal muscle fibers to ensure accurate information regarding muscle length. The need to increase input to the gamma motor neuron is conveyed to the spinal cord via Iα and type II (dynamic and static changes, respectively) afferent fibers from the muscle spindle. These fibers work in concert to create a monosynaptic reflex arc with the alpha motor neuron innervating the corresponding muscle as noted in the patellar tendon reflex. Additionally, this reciprocal relationship between the alpha and gamma motor neurons provides continuous feedback and normal and necessary tone to support joint stability in healthy systems (Riemann and Lephart, 2002b). A loss of calibration of the muscle spindle would result in misinformation to the spinal cord and supraspinal levels. Advances in neuroplasticity illustrate that motor output is directly influenced by sensory input. Faulty afferent information will ultimately result in dysfunctional motor output, creating or perpetuating chronic dysfunction (Needle, Lepley, and Grooms, 2017).
A rare case of intoxication related to concurrent exposure to butane gas and energy drink
Published in Journal of Substance Use, 2021
Nesrin Ceylan, Fatih Mehmet Akif Özdemir, Halil Çelik, Ebru Azapagası, Mutlu Uysal Yazıcı, Deniz Yüksel
A 13 year-old female adolescent with a history of acute loss of consciousness, spasm and abnormal motor movement was referred to the emergency service. The patient had also nausea and retching before she was found to be lying on the floor with moaning, convulsions and cyanosis. In the first hospital where she was admitted, serum biochemical parameters were found to be within reference ranges (excluding glucose 347 mg/dl) and arterial blood gas result had revealed the following: pH 6.68, HCO3 4.2 mEq/L, pCO2 47.6 mmHg. She had no medication at the time of admission. For the initial treatment, the medications including midazolam, diazepam, phenytoin, propofol and Na/bicarbonate replacement with saline solution for the convulsions were started. On admission to our hospital, she was intubated, confused and disoriented with a bad smell. Glasgow coma scoring could not be evaluated due to sedation. Light reflex was positive. Pupillary miosis and isochoric pupils with rotatory nystagmus were also remarkable. Deep tendon reflex was mildly hypoactive at lower extremities and normal at upper extremities. During examination, hypermotor/hyperkinetic choreathetoid movements were accompanied to spasms.
Related Knowledge Centers
- Stretch Reflex
- Tendon
- Spinal Cord
- Patellar Reflex
- Golgi Tendon Reflex