20/12/2025
𝗣𝗼𝗹𝘆𝘀𝘆𝗻𝗮𝗽𝘁𝗶𝗰 𝗥𝗲𝗳𝗹𝗲𝘅𝗲𝘀 𝗦𝗰𝗿𝗲𝗲𝗻𝗶𝗻𝗴 𝗶𝗻 𝗡𝗲𝘂𝗿𝗼𝗹𝗼𝗴𝗶𝗰𝗮𝗹 𝗘𝘅𝗮𝗺𝗶𝗻𝗮𝘁𝗶𝗼𝗻 - Part 2💡
A thorough clinical examination of the upper and lower limbs, including sacral reflexes, is essential when evaluating spinal disorders. Reflex testing not only helps localize the level of the lesion but also aids in differentiating between acute and chronic changes. In addition to deep tendon reflexes, various clinical signs and assessments of muscle tone—such as clonus and stiffness—are used to screen for pyramidal tract or conus lesions (https://link.springer.com/chapter/10.1007/978-3-540-69091-7_11)
✅ 𝗔𝗻𝗮𝗹 𝗥𝗲𝗳𝗹𝗲𝘅 (𝗦2-𝗦4/5)
Rossolimo described the a**l reflex and reported its constant appearance in normal subjects (https://pubmed.ncbi.nlm.nih.gov/690652/). The a**l reflex is also known as the a**l wink (https://pubmed.ncbi.nlm.nih.gov/28555666/), anocutaneous (https://pubmed.ncbi.nlm.nih.gov/11966631/), and cutaneo-a**l reflex (https://pubmed.ncbi.nlm.nih.gov/6315119/) and is a multisynaptic spinal reflex (https://pubmed.ncbi.nlm.nih.gov/6290606/) mediated mainly by S2–4 (https://pubmed.ncbi.nlm.nih.gov/18563721/), while others report S2–5 (https://pmc.ncbi.nlm.nih.gov/articles/PMC6946655/ ). The a**l reflex has been also found to be a clinically feasible approach to assessment of sacral integrity (https://pubmed.ncbi.nlm.nih.gov/8129572/) and a good predictor of recovery of the bladder and bowel functions in cauda equina syndrome (https://pubmed.ncbi.nlm.nih.gov/21594752/). The a**l reflex is usually elicited with pinprick stimulation at the mucocutaneous junction of the a**s and observing for a**l sphincter contraction (https://pubmed.ncbi.nlm.nih.gov/690652/, https://pubmed.ncbi.nlm.nih.gov/18563721/). Afferent pathways of the a**l reflex lie in the pudendal nerve, which synapse in the spinal cord and travel via the inferior hemorrhoidal nerve to the external a**l sphincter muscle (https://pmc.ncbi.nlm.nih.gov/articles/PMC6946655/).
✅ 𝗔𝗯𝗱𝗼𝗺𝗶𝗻𝗮𝗹 𝗥𝗲𝗳𝗹𝗲𝘅𝗲𝘀 (𝗧6-𝗧11)
In superficial abdominal reflexes, stroking the skin of the abdomen causes the underlying abdominal wall muscle to contract, sometimes pulling the umbilicus toward the stimulus. The clinician usually tests one abdominal quadrant at a time using a side-to-side motion with a wooden applicator stick or the pointed end of the reflex hammer handle. The abdominal reflexes appear just as often whether the direction is medial to lateral or lateral to medial. Superficial abdominal reflexes have limited clinical usefulness because they are often absent in healthy individuals—especially the elderly, obese, or those with prior abdominal surgery—and asymmetric or partially preserved reflexes can also be normal.
Although traditionally thought to disappear in both upper and lower motor neuron disease, their findings are usually nonspecific. They are most clinically meaningful when unilaterally absent in a young patient and accompanied by lower-extremity hyperreflexia, which suggests a spinal cord lesion between T9 and T11 on the affected side (https://pubmed.ncbi.nlm.nih.gov/34637397/).
✅ 𝗕𝘂𝗹𝗯𝗼𝗰𝗮𝘃𝗲𝗿𝗻𝗼𝘀𝘂𝘀 𝗥𝗲𝗳𝗹𝗲𝘅 (𝗦2 𝘁𝗼 𝗦4)
The bulbocavernosus reflex is elicited by compressing the g***s p***s or cl****is, which produces reflex contraction of the bulbocavernosus muscle and external a**l sphincter. The response is assessed by palpating behind the sc***um or, more commonly, by feeling sphincter contraction with a finger in the a**l ca**l (https://www.sciencedirect.com/book/monograph/9780323392761/evidence-based-physical-diagnosis). The reflex can also be triggered by suprapubic percussion (https://pubmed.ncbi.nlm.nih.gov/4258642/)
The bulbocavernosus reflex is an important bedside test of the conus medullaris and S2–S4 pelvic nerves, along with perineal (“saddle”) sensation (https://pubmed.ncbi.nlm.nih.gov/7265365/). It is particularly useful in evaluating urinary retention, which may result from pelvic nerve or cauda equina disease. An absent reflex predicts S2–S4 pathology much better in men (LR ≈ 13) than in women (LR ≈ 2.7), likely because prior childbirth or pelvic surgery can damage the pudendal nerve in women. The presence of the reflex is not diagnostically helpful, as it can occur in both common causes of urinary retention (e.g., prostate hypertrophy) and incomplete sacral nerve lesions. In spinal cord injury above S2–S4, the reflex is temporarily absent for 1 to 3 days or even longer (1–6 weeks) before returning (https://www.sciencedirect.com/book/monograph/9780323392761/evidence-based-physical-diagnosis).
✅ 𝗖𝗿𝗲𝗺𝗮𝘀𝘁𝗲𝗿 𝗥𝗲𝗳𝗹𝗲𝘅
The cremasteric reflex is a superficial reflex found in human males that is elicited when the inner part of the thigh is stroked. Stroking of the skin causes the cremaster muscle to contract and pull up the ipsilateral testicle toward the inguinal ca**l. Like other superficial reflexes, it is simply graded as present or absent. A female counterpart of the cremasteric reflex is the Geigel reflex. In the female, it involves the contraction of muscle fibers along the upper part of the Poupart or inguinal ligament and is sometimes called the inguinal reflex. Absence of the cremaster reflex indicates a lesion at the level of L1/2.
📸 Illustration: https://link.springer.com/chapter/10.1007/978-3-540-69091-7_11
