Tendon reflexes differentiate the men from the boys. It is often the cause of many sleepless nights amongst medical students and even the most senior doctors. The variability that exists among patients’ means that there isn’t really a formula one can stick to when trying to elicit a response.
In order to enhance the reflexes in a tense patient, a distraction test is done so that the muscles relax. The text books reckon that one should ask the patient to clench their teeth just before the tendon hammer hits the desired spot.
“Ms J****, could you clench your teeth on the count of three?” I asked the elderly patient, with the tendon hammer ready to swing at her elbows.
“Oh I’m sorry dear, I don’t have any teeth,” as she smiled a toothless grin.
So much for textbooks...
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