Journal of Neurology

, Volume 237, Issue 7, pp 427–431 | Cite as

Reliability of the clinical and electromyographic examination of tendon reflexes

  • J. Stam
  • H. van Crevel
Original Investigations


The reliability of clinical examination of the tendon reflexes was examined by studying inter-observer agreement. Twenty patients were examined by three neurologists. The briskness of the tendon reflexes in arms and legs was scored on a nine-point scale. In 28% of the 160 examined reflexes the observations disagreed 2 scale units or more. Disagreement on the presence of asymmetry occurred in 45% of the 80 reflex pairs. In 15% one observer judged a reflex pair to be symmetrical while another observer found asymmetry of at least 2 scale units. In a second experiment clinical observation of apparently asymmetrical quadriceps reflexes was compared with measurement by surface electromyography. A significant, semi-logarithmic relationship was found between clinical scores and measured reflex amplitudes. Measured reflex asymmetry always agreed with clinical asymmetry, and the magnitudes of right-left amplitude differences were correlated with the magnitude of clinically observed asymmetry. The bedside examination of tendon reflexes is subject to considerable inter-observer disagreement.

Key words

Tendon reflex Neurological examination Surface electromyography 


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Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • J. Stam
    • 1
  • H. van Crevel
    • 1
  1. 1.Department of Neurology, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

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