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Don't forget to do thorough assessment of deep tendon reflexes on physical examination when appropriate. DTR assessment can help localize a lesion and determine a diagnosis (i.e. thyroid disease, Guillain Barre, spinal cord and peripheral nerve lesions).
DTR Assessment Scale:
- 4+ - very brisk, hyperactive with clonus<
- 3+ - brisker than normal
- 2+ - average, normal
- 1+ - somewhat diminished, low normal
- 0 - no response
Major DTR Assessment Locations:
- Triceps (C6, C7)
- Supinator or Brachioradialis (C5, C6)
- Knee (L2, L3, L4)
- Ankle (mainly S1)
- Plantar (L5, S1)