A Guide to Deep Tendon Reflexes

SimpleNursing Editorial Team May 26, 2023
Pediatric nurse checking baby patient with reflex hammer

Deep tendon reflexes (DTRs) are integral to the neurological exam and can provide valuable information about a patient’s nervous system. As a nursing student, understanding deep tendon reflexes is crucial to your education. 

Whether you’re just starting or nearing graduation, grasping the concepts to provide effective patient care is essential. Nurses need to understand how to perform and interpret these tests to identify potential neurological issues.

Jump to Reflexes


  1. Brachioradialis
  2. Biceps
  3. Patellar
  4. Achilles
  5. Triceps

What are deep tendon reflexes?

Deep tendon reflexes are involuntary muscle contractions that occur when a specific tendon is stretched. They are also known as myotatic reflexes and are part of the neurological assessment. 

The spinal cord and the brain control these reflexes. Therefore, proper technique and interpretation of results are crucial in distinguishing different diseases, such as MS, ALS, and spinal cord injuries.

Brachioradialis Reflex

The brachioradialis reflex is elicited by tapping the tendon that connects the brachioradialis muscle to the radial bone in the forearm. The patient’s arm should be semi-flexed, with the thumb pointing upward. A normal response is the contraction of the brachioradialis muscle and flexion of the forearm.

Biceps Reflex

The biceps reflex is elicited by tapping the biceps tendon located in the antecubital fossa. The patient’s arm should be slightly flexed, with the palm facing up. A normal response is the contraction of the biceps muscle and flexion of the forearm.

Patellar Reflex

The patellar reflex is elicited by tapping the patellar tendon located just below the patella. The patient’s leg should hang freely, with the knee slightly flexed. A normal response is the contraction of the quadriceps muscle and extension of the leg.

Achilles Reflex

The Achilles reflex is elicited by tapping the Achilles tendon located at the back of the ankle. The patient’s foot should be relaxed, with the knee slightly flexed. A normal response is the contraction of the calf muscles and plantarflexion of the foot.

Triceps Reflex

The triceps reflex is elicited by tapping the triceps tendon located above the olecranon process. The patient’s arm should be slightly flexed, with the palm facing down. A normal response is the contraction of the triceps muscle and extension of the arm.

Grading Deep Tendon Reflexes

Deep tendon reflexes are graded on a scale of zero to four. A score of zero indicates no response, while a score of four indicates a brisk, hyperactive response. A score of two is considered normal.

Deep Tendon Reflexes Scale 

0 – No response

1 – Diminished response

2 – Normal response

3 – Brisk response

4 – Hyperactive response

Go Beyond Your Nursing School Classroom

To succeed in your nursing program and career, it’s crucial to have a deep understanding of deep tendon reflexes. They are essential to the neurological exam and can provide valuable information about a patient’s nervous system. 

Using a digital nursing school study tool like SimpleNursing helps you master this topic. With interactive quizzes, flashcards, and practice questions, you can solidify your knowledge and gain confidence in performing and interpreting deep tendon reflexes.

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