Physical examination maneuver
Physical Exam
Achilles Deep Tendon Reflex
also known as Ankle jerk
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Video coming soon
How to Perform
With the ankle relaxed, support the forefoot and slightly dorsiflex the ankle (cross the leg over the opposite knee or have the patient kneel on a chair if needed). Strike the Achilles tendon just above its insertion on the calcaneus with the reflex hammer. Compare both sides.
How to Interpret
Showing 6 of 11 findings
Hypothyroidism
Hung-up Achilles reflex
Rule in
Somewhat helpful
Rule out
Minimally helpfulDerived CI
Evidence:Moderate
Lumbosacral Radiculopathy
Hyporeflexia (≤1+) at Achilles
Rule in
Not helpful
Rule out
Not helpful
Evidence:Moderate
Peripheral Neuropathy
Lower-extremity bedside cluster positive (≥2 of 3: Achilles reflex absent despite facilitation, vibration <10 seconds at toe with 128-Hz tuning fork, or position sense <8 of 10 1-cm trials at toe)
Rule in
HelpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate
Multi-level hyporeflexia pattern (all deep tendon reflexes impaired)
Rule in
Very helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate
Hyporeflexia (≤1+) at Achilles
Rule in
Somewhat helpfulDerived CI
Rule out
HelpfulDerived CI
Evidence:Moderate
Lower-extremity hyporeflexia pattern (Achilles + patellar both impaired)
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate
Related Bedside Tests
🎬Video coming soon
Patellar Deep Tendon Reflex
aka Knee jerk
Rule in:VHLumbosacral Radiculopathy, VHPeripheral Neuropathy, IECerebellar Disease +5 more
Rule out:SHPeripheral Neuropathy, ICLumbosacral Radiculopathy, IECerebellar Disease +5 more
🎬Video coming soon
Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more
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Biceps Deep Tendon Reflex
aka Biceps jerk
Rule in:VHPeripheral Neuropathy, SHCervical Radiculopathy, IECervical Myelopathy +2 more
Rule out:MHPeripheral Neuropathy, NHCervical Radiculopathy, IECervical Myelopathy +2 more
🎬Video coming soon
Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, HMultiple System Atrophy +4 more
Rule out:SHUpper Motor Neuron Lesion, MHMultiple System Atrophy, NHVascular Parkinsonism +4 more
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Head and Face Inspection
Rule in:HAcromegaly, HStroke, SHCushing Syndrome +5 more
Rule out:SHAcromegaly, SHCushing Syndrome, SHStroke +5 more
🎬Video coming soon
Edema Assessment
Rule in:SHAscites, SHCirrhosis, SHCushing Syndrome +14 more
Rule out:HAscites, MHHeart Failure, NHCirrhosis +14 more