Test: DTR Brachioradialis reflex

Video Link

Background/Purpose

The brachioradialis reflex (also known as supinator reflex)is observed during a neurological exam by striking the brachioradialis tendon (at its insertion at the base of the wrist into the radial styloid process (radial side of wrist around 4 inches proximal to base of thumb)) directly with a reflex hammer when the patient's arm is relaxing. This reflex is carried by the radial nerve (spinal level: C6, C7)

The reflex should cause slight wrist extension and/or radial deviation, supination[1] and slight elbow flexion.

Procedure

The patient's arm should be supported. Identify the brachioradialis tendon at the wrist. It inserts at the base of the styloid process of the radius, usually about 1 cm lateral to the radial artery. If in doubt, ask the patient to hold the arm as if in a sling—flexed at the elbow and halfway between pronation and supination—and then flex the forearm at the elbow against resistance from you. The brachioradialis and its tendon will then stand out.

Place the thumb of the hand supporting the patient's elbow on the biceps tendon while tapping the brachioradialis tendon with the other hand. Observe three potential reflexes as you tap.

Brachioradialis reflex: flexion and supination of the forearm.
Biceps reflex: flexion of the forearm. You will feel the biceps tendon contract if the biceps reflex is stimulated by the tap on the brachioradialis tendon.

Finger jerk: flexion of the fingers.
The usual pattern is for only the brachioradialis reflex to be stimulated. But in the presence of a hyperactive biceps or finger jerk reflex, these reflexes may be stimulated also.

Grade
0 = no response; always abnormal
1+ = a slight but definitely present response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may not be normal
4+ = a tap elicits a repeating reflex (clonus); always abnormal
Performed: Unilaterally

Dialog

Tap the brachioradialis tendond 1 cm from styloid

Criteria

• Normal reflex jerk response. +1 to +3

Measurement

0.00

LOINC Code

0

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC ID0 No Response = ; Fail - 1+ Slight Response = ; Fail - 2+ Brisk Response = ; Pass - 3+ Very Brisk Response = ; Fail - 4+ Clonus = ; Fail -