Tricep Reflex Grading

Standard Grading Scale

The deep tendon reflex grading system applies uniformly to the tricep reflex, with a scale of 0-4+, where 0 indicates absent reflex, 1+ is diminished, 2+ is normal, 3+ is brisker than average, and 4+ is hyperactive with clonus, as per the American Academy of Pediatrics 1
A grade of 1+ indicates a diminished or hypoactive reflex, with a trace response that is less than normal 1
A grade of 3+ indicates a brisker than average reflex, which may be possibly but not necessarily pathologic 1
A grade of 4+ indicates a hyperactive reflex with clonus, which is definitively abnormal 1

To properly elicit the tricep reflex, the patient's arm should be positioned flexed at approximately 90 degrees at the elbow, with the arm supported either by holding it or having it rest comfortably, as recommended by the American Academy of Pediatrics 1
The triceps tendon should be struck directly above the olecranon process with a reflex hammer, and the response should be observed for elbow extension as the triceps contracts 1
Both sides should be tested for comparison and symmetry, to aid in the identification of any potential pathology 1

Diminished or absent reflexes (0-1+) may indicate lower motor neuron dysfunction, including peripheral neuropathy, nerve root compression, anterior horn cell disease, neuromuscular junction disorders, or myopathies, according to the American Academy of Pediatrics 1
Hyperactive reflexes (3-4+) may indicate upper motor neuron dysfunction, including corticospinal tract lesions, spinal cord pathology, or cerebral lesions affecting motor pathways, as per the American Academy of Pediatrics 1

Asymmetry in reflexes is often more significant than the absolute grade, and comparison of reflexes bilaterally may indicate focal pathology, even when both sides fall within the "normal" range, as recommended by the American Academy of Pediatrics 1
The tricep reflex specifically tests the C7-C8 nerve roots and radial nerve integrity, making it valuable for localizing cervical radiculopathy or peripheral nerve lesions, according to the American Academy of Pediatrics 1
Documentation of the patient's level of cooperation and any factors affecting the examination, such as anxiety or medications, can aid in the interpretation of the reflex response, as per the American Academy of Pediatrics 1