Peroneal reflex

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The peroneal reflex is one of occasionally useful deep tendon reflexes.(1) The innervation is by the peroneal nerve and primarily the L5 root.(2) In normals, it is not very active and may be difficult to elicit, but some individuals have elicitable peroneal reflexes. Like the medial hamstring reflex, the peroneal reflex is most useful in the evaluation of suspected L5 radiculopathy, when depression of the reflex helps confirm a lesion of the L5 root.(3,4) The medial hamstring is more useful because most patients have medial and lateral hamstring reflexes.

This patient was suffering with left buttock and leg pain. Her MRI showed a large paracentral disc and severe spinal stenosis. There was no weakness but the left medial hamstring reflex was absent. The absent left peroneal reflex provided further confirmation of an L5 radiculopathy.

Other occasionally useful reflexes (1):

Orbicularis oculi Jaw Clavicle Pectoralis Deltoid Pronator Finger flexor Deep abdominal Suprapatellar Hamstring Adductor Extensor digitorum brevis Tibialis posterior Plantar stretch

References

1. Campbell WW. Clinical signs in neurology: a compendium. Philadelphia: Wolters Kluwer Health, 2016. 2. Campbell WW. DeJong's the neurologic examination 3. Esene IN, Meher A, Elzoghby MA, El-Bahy K, Kotb A, El-Hakim A. Diagnostic performance of the medial hamstring reflex in L5 radiculopathy. Surg Neurol Int. 2012;3:104 4. Perloff MD, Leroy AM, Ensrud ER. Teaching video neuroimages: the elusive L5 reflex. Neurology. 2010 Sep 14;75(11):e50.