The physicians trying to figure out my problem keep talking about my "deep tendon reflexes," especially my ankles and knees. Could you please help me understand some basics? For example: (1) When a tendon relex (e.g., the ankle) "doesn't work right," what does that tell a physician about the nerve function (or whatever it is)? (2)What does the scale they use mean, e.g., "1+," "2+" and so fourth? (3) Doe "1+" mean the same thing as "+1"? (4)I hear them also talking about "small fibers" and "large fibers." Which one of those (small or large) are the tendon reflexes about?
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Deep tendon reflexes test an arc of sensory input that travels through the spinal cord and results in muscle contraction. Each reflex corresponds to a certain level of the cord, for example the "ankle Jerk" is testing the first sacral nerve root. Reflexes are graded on a scale 0-4, with 0 being absent, 1 being underactive, 2 and 3 being average, and 4 being clearly heyperactive. 1+ and +1 have the same meaning. In general, reflexes are not pathological if symmetric unless they are absent or hyperreflexic. Assymetry of reflexes and absent reflexes tend to localize to a peripheral nervous system process. Increased reflexes tend to indicate a problem of the central nervous sytem. Reflexes are routinely tested on neuro exam and are nonspecific as to the etiology of the disease process if abnormal. They provide information to help localize the problem. Very seldom is one or more abnormal reflexes the only abnormality. More often, abnormal reflexes corroborate other symptoms and sign. Small and large fiber refer to the diameter of specific sensory nerves. Larger fibers are responsible for vibratory sensation and joint position. Small fibers are responsible for conveying pain and temperature sensation. In small fiber neuropathies, tendon reflexes may be retained. I hope this answers your questions. If ever you are interested in getting an evaluation at CCF, call 1-800-CCF-CARE. Good Lick.
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