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Study Guide Questions: 5.4

1. Unlike extremity reflexes which use muscle spindles to trigger the response,
most superficial reflexes are cutaneous reflexes, provoked by scraping of skin
stimuli to a localized area of skin
example:babinski –like reflexes

2. Are superficial reflexes graded? What term is used to describe the

superficial reflexes?
(a)Yes (+) = normal response example Babinski dorsiflexion of first toe & fanning of
digits 2-5= pyramidal tract lesion (upper moter neuron lesion)
(b)The term used to describe the superficial reflexes are the Doctor name who
developed the procedure e.g.
*Babinski,Trommers,Gordons,hoffmans etc

(refer: orthopaedic assessment .Vizniak pg109-111)

3. What type of problem is it when the superficial reflexes are absent

bilaterally?
Upper motor neurons of the corticospinal tract project from the cerebral cortex to
the lower motor neurons located in the anterior horn of the spinal cord .
Lower motor neurons in turn project via peripheral nerves to the skeletal muscle
(Neuroanatomy, Blumenfeld pg 241)
Therefore there must be a blockage in LMN (however there may be signs in the
Upper motor Neurons lesions UMNL) for example
*weakness
*increased reflexes
*increased tone

In the case of Bilateral Arm and Leg weakness or paralysis .

Possible causes : tumor, Infart, trauma, multiple sclerosis.
(Neuroanatomy, Blumenfeld pg 249)

4. What type of problem is in when the superficial reflexes are absent

unilaterally?
Locations ruled In: corticospinal and corticobulbar tract fibres below the cortex and
above the medulla/
Side of Lesion : contralateral to weakness (above pyramidal decussation)
Associated features: UMN signs usually present (weakness,reflexes increased,tone
increases)
Common causes: demyelination,tumor,abscess,
(Neuroanatomy, Blumenfeld pg 243)
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Case study 1

Jack is a 40-year-old labourer who has decided to change his career. He has
decided to enroll into University and has been undertaking his studies now for
around two years. Jack now presents to you with headaches which seem to be
worse with studying. Upon taking the case history, he mentions his mother suffers
the same problem

ASSUME ALL OTHER EXAMINATION AND CASE HISTORY FINDINGS ARE

UNREMARKABLE.

Jack has been diagnosed with tension headaches.

1. List the statements (clues) in the case history that aligns with the
diagnosis of tension headaches. Use the script concordance. (Found in
Moodle)
if you were thinking ? and you find: hypothesis becomes (-2,-1,0+1,+2)
*1) myofascial trigger point pain cervical +2
*2) vascular (atherosclerosis)+2
*3) History of Mother ?
*4)
*5)
*6)
*7)
2. The above case history is incomplete. What further questions or what
information would you need to acquire?
Apply LOD-CT-RRAPPA in complete process
a. List the muscles (trigger points that are likely to refer pain to the head
*leading to tension headaches?
*Splenius capitis & Cervicis
*Sub occipital
*Sternocleidomastoid
*Trapezius
*Temporalis
*masseter
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For case study 1 indicate the likely

outcome for the following tests. Is it
likely to be positive or negative?
Discuss false positives and
negatives.
Pelvic Rock Test Given he was laborer a possible (+)
SIJ issues if determined
Hoovers Test (-) malingering ? no reason for it

Stoop Test Possible (+) as may be a consequence

Brachial Plexus Nerve Tension Test
Upper Limb Nerve Tension Test 1
(ULNNT)
or atherosclerosis if determined in family
history
Possible (+) if the headaches are of
origin in scalenes or any TOS symptoms
(-) should be negative as is test for
median nerve similar to above test

Gluteal Reflexes Should be (-) as contradiction of the

Superficial Visceral Abdominal
Reflexes
Gluteal muscle is irrelevant to
headaches (apart from studying being a
pain in the butt  )
(-) reflexes of abdominals irrelevant

Djerine’s Triad (Cough,Valsalva and (-) negative

Sneeze) a increase of intrathecal pressure =
space occupying lesion /disc herniation
however may related to headache if
herniation is in cervical segment but
highly unlikely
Lhermittes Sign Probable (-) as this test more focused on
radicular symptoms = cervical
radiculopathy
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