This document discusses several forgotten reflex tests including: - The ciliospinal reflex which evaluates C8-T2 nerve roots and sympathetic outflow. - The pectoral reflex which assesses C5/6 and C7/8 nerve roots via percussion of the deltopectoral groove. Hyperactivity correlates with cord lesions at C2/C3 and C3/C4. - The Hoffman reflex which assesses the C8-T1 reflex arc and is an upper motor neuron sign. - The superficial abdominal cutaneous reflex which evaluates T8-T12 nerve roots with loss indicating a loss of reflex arc. - The mesial hamstring reflex which

1. Forgotten Reflex Testing

2. Ciliospinal Reflex
 Evaluated nerve roots C8-T2 and
sympathetic outflow
 Absent in Horner’s and cervical
sympathetic lesions as well as
brain death
 May be enhanced in patient’s
with cluster headache
 More pronounced in sleep and
comatose patients
 Unaffected in 1st order
sympathetic injury

3. Jaw Jerk Reflex
The response to the stimulus is monosynaptic, with sensory
neurons of the trigeminal mesencephalic nucleus sending axons
to the trigeminal motor nucleus, which in turn innervates the
masseter

4. Pectoral Reflex
 Pectoral - medial and lateral
pectoral nerves, C5/6 (clavicular
head) & C7/8, T1 (sternocostal
head)
 Percussion at the deltopectoral
groove
 Hyperactivity correlates with cord
lesion at C2/C3 and C3/C4

5. Hoffman Reflex (Finger Flexors)
UMN sign
Reflective of
C8-T1 reflex
arc activity

6. Superficial Abdominal Cutaneous
Reflex
 Abdominal above umbilicus
 T8, T9, T10
 Abdominal below umbilicus
 T10, T11, T12
 Loss of abdominal cutaneous
reflex
 Absent on the side contralateral to
an upper motor neuron lesion
 Usually associated with
hyperactive DTRs
 When isolated there is a loss of a
reflex arc

7. Mesial Hamstring Reflex
Of all the lower extremity DTRs, the mesial
hamstring reflex correlates best with an L5
radiculopathy

8. Cremasteric Reflex: Basics
 Reflex is elicited by stroking the mesial thigh causing an ipsilateral
contraction of the cremasteric muscle
 Brings testicle closer to the external inguinal ring
 Reflex test L1-L2 (genitofemoral nerve responsible for afferent and
efferent limbs)
 Typically absent in testicular torsion
 Negative predictive value of over 90%

9. Cremasteric Reflex

10. Crossed Adductor Reflex
 Often elicited with striking the
contralateral quad tendon
 Alternative (and my preferred)
striking hand that covers the
mesial knee and watching for
contralateral adduction
 Tibioadductor reflex is a variant

11. Bulbocavernosis Reflex
 Squeeze the head of the penis or
the clitoris or tugging on a Foley
catheter with resultant contraction
of the anal sphincter
 Dependent on S1-S3
 When spinal cord injury is present it
is an indicator of spinal cord shock
 Return of reflex suggests the end of
spinal shock
 Can be one of the first reflexes to
return
 In the absence of cord signs, it
can indicated sacral nerve root
injury

12. Glabellar Reflex
 Often associated with
Parkinson’s disease
 Probably a frontal lobe
release sign that can
been seen in a number of
dementing illness

13. Frontal Lobe Release Phenomenon
Snout Reflex Palmomental Reflex