Execution
- 1Have the patient sit relaxed with the tested limb supported.
- 2Place the target tendon on slight stretch and taps with a reflex hammer.
- 3Commonly test biceps C5-C6, brachioradialis C5-C6, and triceps C7-C8.
- 4Compare amplitude and symmetry side to side and repeat if the response is unclear.
- 5Use reinforcement if required and interpret reflex change with sensory and myotomal findings.
Positive outcome
Hyporeflexia or loss of a reflex may suggest lower motor neuron or nerve root involvement. Hyperreflexia, clonus, or pathological reflexes suggest possible upper motor neuron involvement and require escalation.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Wainner et al. (2003) | NA | 3-24 | 93-96 | 0.80-1.05 | 0.95-4.92 |
| Rubinstein et al. (2007) | NA | 8-10 | 95-99 | 2.0-10.0 | 0.91-0.95 |
CommentReflex loss is generally specific but poorly sensitive for cervical radiculopathy. Reflex findings are most useful when they match a root-level motor and sensory pattern. Rating note: Wainner reported LR+ 0.80–1.05 and Rubinstein 2007 reported LR+ 2.0–10.0 across reflexes — the upper Rubinstein range puts the strongest reflex finding (typically biceps for C5-6) into the moderate rule-in band. The rating reflects best-evidence yield; isolated reflex loss alone with low Wainner-range LR+ is closer to a low-yield finding.
Moderate Clinical Value