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Orthopaedics
Medial Hamstring Reflex MHR
Built from Pillemer — Physical Signs in Orthopaedics and Neurology
What’s inside
6 sections · 43 slides
Overview
- What this topic teaches you
- How we will build the picture
- The big idea in one slide
The Medial Hamstring Reflex
What it is and how to elicit it
- First principles: what a tendon reflex is
- What is the medial hamstring reflex?
- Why such a useful sign is barely used
- How to test the MHR, step by step
- Eliciting the medial hamstring reflex
- Reading the result
The Full L5 Picture
Motor, sensory, and reflex findings together
- What is L5 radiculopathy?
- The L5 triad: three things to check
- Putting the triad together
The Extensor Digitorum Brevis Sign
A small foot muscle that reveals L5 wasting
- A less common L5 sign: the EDB muscle
- The muscle belly of extensor digitorum brevis
- Where the EDB comes from and where it goes
- Origin of extensor digitorum brevis on the heel bone
- The big-toe portion: EHB
- Insertions of the short toe extensors
- The long toe extensors lying over the short ones
- Why EDB wasting is a useful clue
- Normal versus wasted short toe extensor
- Marked wasting of the short toe extensor in L5 lesion
The Peroneal Reflex
A second L5-linked reflex at the foot
- Another less common L5 sign: the peroneal reflex
- How to elicit the peroneal reflex
- Eliciting the peroneal reflex
L5 Root versus Peroneal Nerve
Separating two look-alike causes of foot drop
- The core problem: two look-alikes
- Do not forget the other causes of foot drop
- Why sensation and motor loss look so alike
- Sensory loss in peroneal nerve versus L5 lesions
- Five ways to tell them apart
- Five ways to tell them apart (continued)
- Summary table: L5 root versus common peroneal nerve
- Reading the pattern at a glance
- Key takeaways
- How does the medial hamstring reflex help you tell an L5 root lesion from a common peroneal nerve lesion?
- References
- Physical Signs in Orthopedic and Neurologic Disorders: A Practical Guide