Periosteal Reflexes

PERIOSTEAL REFLEXES (syn. periosteal reflexes) are caused by percussion of bony prominences and manifest as involuntary rapid and short muscle contractions. Based on clinical and experimental data, periosteal reflexes are grouped together with tendon reflexes. At present, the majority consider periosteal reflexes to be true reflexes rather than phenomena caused by direct muscle irritation without participation of the reflex arc. Opinions on the nature of the initial irritation diverge. Some consider that periosteal reflexes are caused by irritation of sensitive nerve endings in the periosteum. According to others, periosteal reflexes are intrinsic muscle reflexes, i.e., they are a response to irritation of sensitive nerve endings in the muscle itself, which, upon percussion, is stretched longitudinally or shaken. The following periosteal reflexes are used in clinical practice. I. In the head region: supraorbital reflex (MacCarthy); caused by percussion of the supraorbital arch and manifests as contraction of the circular muscles of the eyelids. A variant of this reflex is the nasopalpebral reflex (Guillain). II. In the trunk region: 1) pubic reflex (Guillain, Alajouanine); caused in the supine position by strong percussion of the pubic symphysis and manifests as contraction of the adductor muscles of the thigh and muscles of the anterior abdominal wall. In cases of increased reflex excitability, contraction of both large pectoral muscles joins this reflex. 2) Sternum reflex (same authors); caused by strong percussion of the body of the sternum and manifests as contraction of the large pectoral muscles on both sides, and often also the abdominal wall muscles. 3) Lumbo-sacral reflex (Bechterev); caused with the trunk slightly bent by percussion of the upper sacral region or the lower lumbar region and manifests as contraction of the spinal extensors on the same side. Observed in healthy children, and in adults in cases of damage to the pyramidal pathways. III. In the shoulder girdle and upper limbs: 1) deltoid reflex; caused by percussion of the vertebral border of the scapula and manifests as contraction of the deltoid muscle. 2) Scapulohumeral reflex (Bechterev); the method of induction is the same; manifests as contraction of the subscapularis and small round muscles. 3) Acromial reflex; caused by percussion of the acromion and manifests as slight pronation and flexion of the forearm and sometimes flexion of the fingers. 4) Radial, or flexor reflex (Babinski); in healthy individuals it is caused in 95% of cases by percussion of the distal end of the radius (radial styloid process) and manifests as contraction of the muscles that flex the forearm (biceps and long supinator). Often a slight flexion of the fingers occurs simultaneously. The spinal center of this reflex is localized in C_VI (flexion of the forearm) and C_VII (flexion of the fingers). Sometimes dissociation of the radial reflex is observed. In this case, only the flexors of the hand and fingers contract and flexion of the forearm is absent. On this basis, one can conclude damage to C_VI and preservation of C_VII (Babinski). 5) Ulnar reflex (pronator reflex-Babinski, ulnar-pronator reflex-P. Marie and Wagge); caused by percussion of the dorsal surface of the distal end of the ulna (ulnar styloid process) and manifests as slight pronation and sometimes, in addition, slight flexion of the fingers. The spinal center of the ulnar reflex is localized in the region of C_VI. 6) Humeral epicondyle reflex; caused by percussion of the humeral epicondyle and manifests as slight flexion of the forearm and fingers with slight supination. 7) Palmar-digital reflex (Bechterev); caused by percussion of the dorsum of the metacarpus or wrist and manifests as flexion of the fingers. Common in the stage of contractures in hemiplegics, but sometimes occurs in cases of increased reflex excitability of non-organic origin. IV. In the lower limbs. 1) Plantar reflex (Guillain and Wagge); caused by percussion of the sole and manifests as contraction of the calf muscles. 2) Dorsal foot reflex; caused also by percussion of the dorsum of the foot and manifests as contraction of the dorsal foot flexors. 3) Mendel-Bechterev reflex - see Mendel-Bechterev reflex. 4) Adductor thigh reflex; in healthy individuals it is caused in 90% of cases by percussion of the medial epicondyle of the femur and manifests as contraction of the adductor muscles of the thigh. In cases of increased reflex excitability, the adductor thigh reflex is caused by percussion of the tibia. In this case, contraction of the quadriceps and internal rotators of the thigh also occurs. Sometimes under the same conditions, the adductor thigh reflex is caused by percussion of the sole. In cases of bilateral increased reflex excitability, it is possible to induce a bilateral adductor thigh reflex. With unilateral increased reflex excitability, a contralateral adductor thigh reflex is induced by percussion of the healthy side. The spinal center of the adductor thigh reflex is localized in the region of L_III-L_IV. 5) Gluteal reflex; caused by percussion of the greater trochanter in healthy individuals, especially under conditions of increased reflex excitability, and manifests as contraction of the gluteal muscles.

Pathological changes in periosteal reflexes are expressed mainly in their absence, decrease, or increase. Absence or decrease of periosteal reflexes is most often the result of damage to the spinal reflex arc, i.e., either the centripetal sensory neuron (nerves, roots) or the peripheral motor neuron (motor cells of the anterior horns of the spinal cord, roots, nerves, and muscles) and occurs 1) in damage to motor cells of the anterior horns (acute or chronic poliomyelitis); 2) in damage to posterior roots (radiculitis, tabes dorsalis); 3) in damage to peripheral nerves (neuritis, polyneuritis, nerve injuries); 4) in deep muscle damage (myositis). But besides cases of damage to the spinal reflex arc, absence or decrease of periosteal reflexes is observed 1) in apoplectic stroke in the comatose phase and in the beginning of the recovery phase; 2) in complete transverse damage to the spinal cord in the phase of spinal coma (Roussy, Lhermitte); 3) in some cases of paraplegia with flexor contractures of the lower limbs; 4) in some cases of increased intracranial pressure. Increased periosteal reflexes in organic cases are the result of damage to the central motor neuron and are observed in spastic hemiplegias and paraplegias, as well as in a certain stage of flaccid paralysis. It occurs 1) in damage to the brain (cerebral organic hemiplegias due to focal damage); 2) in cases of damage to the spinal cord (myelitis, syringomyelia, amyotrophic lateral sclerosis, multiple sclerosis, etc.); 3) in cases of irritation of the central motor neuron (tumors, scars, meningeal hemorrhages, Pott's disease); 4) in the initial period of some exceptional cases of damage to the peripheral neuron; and 5) in diseases of the joints.