Eliciting the muscle stretch reflexes requires special handling of the reflex hammer. Select a properly weighted reflex hammer, and learn the different uses of the pointed end and the flat end. For example, the pointed end is useful for striking small areas, such as your finger as it overlies the biceps tendon. Test the reflexes as follows:

■ Encourage the patient to relax, then position the limbs properly and symmetrically.

Hold the reflex hammer loosely between your thumb and index finger so that it swings freely in an arc within the limits set by your palm and other fingers (Fig. 1).

FIGURE 1. Strike with a brisk relaxed swing.

■ With your wrist relaxed, strike the tendon briskly using a rapid wrist movement. Your strike should be quick and direct, not glancing.

Note the speed, force, and amplitude of the reflex response and grade the response using the scale below. Always compare the response of one side with the other. Reflexes are usually graded on a 0 to 4 scale.

Reflex response depends partly on the force of your strike on the tendon. Use only enough force to provoke a definite response. Differences between sides are usually easier to detect than symmetric changes on both sides. Symmetrically increased, diminished, or even absent reflexes can be normal.

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