Article

The significance of an absent ankle reflex.

West Suffolk Hospital, Bury St Edmunds, UK.
Journal of Bone and Joint Surgery - British Volume (Impact Factor: 2.69). 04/1996; 78(2):276-9.
Source: PubMed

ABSTRACT We assessed the prevalence of abnormal ankle reflexes in 1074 adult patients attending orthopaedic clinics and related it to age. Those with possible pathological causes of reflex loss were excluded. The absence of one or both reflexes was significantly related to increasing age; all patients under 30 years had both reflexes. Few had absent reflexes between 30 and 40 years, but over 40 years, the proportion with both reflexes absent increased rapidly from 5% (40 to 50 years) to 80% (90 to 100 years). Unilateral absence did not show the same pattern of increase being 3% to 5% at 40 to 60 years and 7% to 10% at over 60 years. Our results suggest that a significant number of 'normal' adults have unilateral absence of an ankle reflex, but this finding is rare enough to be a definite clinical sign, irrespective of age.

0 Bookmarks
 · 
254 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Vibration perception threshold (VPT) is considered as a gold standard for diagnosis of diabetic peripheral neuropathy. However, the data are sparse comparing the VPT with commonly used bedside modalities. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy in patients with diabetes mellitus. A total of 1044 patients with diabetes mellitus attending the Diabetes clinic from January 2007 to May 2008, were included in this study. All subjects had a detailed clinical assessment including Diabetic Neuropathy Symptom (DNS) score, Diabetic Neuropathy Examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, 10 g Semmes-Weinstein monofilament and vibration perception threshold (VPT). The prevalence of peripheral neuropathy was 34.9 per cent with VPT. Foot care practices were followed by only 214 (20.5%) of the study population. When compared with VPT, ankle reflex was the most sensitive (90.7%) but least specific (37.3%). The tuning fork and monofilament tests respectively had lower sensitivity (62.5 and 62.8%) but better specificity (95.3 and 92.9%) and accuracy (78.9 and 77.9%). Significant correlations were observed between the VPT score and the DNE (r = 0.532, P<0.001) and DNS (r = 0.546, P<0.001) scores and absent tuning fork sensation (r = 0.590; P<0.001), monofilament sensation (r = 0.573; P<0.001) and ankle reflex (r = 0.377, P = 0.01). The present findings show that simple bed side tests are useful for assessing peripheral diabetic neuropathy, even in those subjects in whom foot care practices are not followed.
    The Indian Journal of Medical Research 06/2011; 133:645-9. · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Back pain is one of the most common symptom-related complaints for visits to primary care physicians and is the most common musculoskeletal complaint that results in visits to the emergency department (ED). With recent national health care initiatives moving toward universal coverage, an increasing number of patients with common complaints such as back pain will visit the ED. The first goal of ED assessment of patients with back pain is to evaluate for potentially dangerous causes that, if not promptly recognized, could result in significant morbidity and mortality. This article focuses on the essential elements of an efficient and effective evaluation, management and treatment of patients with back pain in the ED, with special emphasis on epidural abscess, epidural compression syndrome, malignancy, spinal stenosis, and back pain in children.
    Emergency medicine clinics of North America 11/2010; 28(4):811-39. · 0.96 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ankle reflex is a simple screening tool frequently used in the detection of peripheral neuropathy. The purpose of this study is to assess the performance characteristics of ankle reflex in detecting diabetic peripheral neuropathy (DPN) by evaluating the sensitivity, specificity and the predictive ability of the ankle reflex, a component of Neuropathy Disability Score (NDS) with reference to Nerve Conduction Studies (NCS). A total of 151 patients with type 2 diabetes were assessed (47 males, 104 females). Grading of neuropathy was done using Neuropathy Symptom Score (NSS), NDS and NCS. Patients were divided into two groups, those with abnormal NCS (Group 1) and those with normal NCS (Group 2). Demographic characteristics, biochemistry, NSS and NDS were assessed between the two groups. Taking NCS as the gold standard, sensitivity, specificity and predictive ability of the ankle reflex were calculated and compared with other tests included in NDS, namely vibration sense, superficial pain and temperature sensation. There were 59 (39.1%) patients in Group 1 and 92 (60.9%) in Group 2. NSS and NDS demonstrated strong positive association with NCS. Taking NCS as the gold standard, ankle reflex yielded the highest sensitivity and specificity (91.5 and 67.4%, respectively), closely followed by that of vibration sense. Ankle reflex is a powerful screening tool with high sensitivity and negative predictive value, but a combination of ankle reflex and vibration sense has superior sensitivity and specificity compared with either of them done alone for the detection of DPN in clinical settings.
    QJM: monthly journal of the Association of Physicians 11/2011; 105(4):315-20. · 2.36 Impact Factor

Full-text

View
1 Download
Available from