Upper Limb Reflex Testing | Peripheral Neurological Examination

Reflex assessment is an essential part of neurological examination when suspecting radiculopathy as abnormal deep tendon reflexes may help you identify the pathological disc level.
in their systematic review from 2017,  Lemeunier et al. report that a complete peripheral neurological examination when suspecting cervical radiculopathy has a sensitivity of 83% and specificity of 28%. The positive and negative likelihood ratios were 1.15 and 0.6 respectively, which is why we attribute this assessment a rather weak clinical value but it is  still the best tool we have.

The most important upper extremity reflexes are the biceps tendon reflex for levels C5, C6 and the triceps tendon reflex for level C7.  

You can grade the reflex according to a commonly used 5 grade scale: 

0= no response, which is always abnormal

1+= slight but definitely present response, which may or may not be normal 

2+= brisk response, which is usually considered normal

3+= very brisk response, which may or may not be normal

4+= clonus, which is always abnormal

Biceps Reflex: 24% Sn, 95% Sp

With the patient in a recumbent position, slightly flex the forearm, palpate the biceps tendon and apply a brisk tap to it using a reflex hammer. 

Triceps reflex:

Bring the patient’s arm into slight abduction and with the relaxed forearm hanging freely. To elicit the triceps reflex, tap the tendon at the proximal to the olecranon.

Other parts of the neurological examination of the upper limb are:

• Dermatome Testing (Upper Limb)
• Myotome Testing (Upper Limb)
• Reflex Testing (Lower Limb)

For the lower limb, the neurological examination can be studied here:

• Dermatome Testing (Lower Limb)
• Myotome Testing (Lower Limb)
• Reflex Testing (Lower Limb)

Lemeunier, N., da Silva-Oolup, S., Chow, N., Southerst, D., Carroll, L., Wong, J. J., … & Côté, P. (2017). Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. European Spine Journal, 26(9), 2225-2241.