T-Reflex Studies in Human Upper Limb Muscles During Voluntary Contraction: Normative Data and Diagnostic Value for Cervical Radiculopathy

Abstract

ObjectiveTo evaluate the diagnostic utility of the T reflexes elicited from the upper limb muscles during standardized volitional contraction monitored by a real-time integrating electromyographic analyzer. DesignProspective descriptive study. SettingDepartment of orthopedic surgery at a university hospital. ParticipantsHealthy subjects (n=80) evenly distributed across decades of age from 21 to 79 years, and 12 consecutive patients with a single cervical root lesion based on clinical and magnetic resonance imaging studies and diagnostic block. InterventionsNot applicable. Main Outcome MeasuresUsing a special hammer, which externally triggers the sweep on skin contact, we evoked T reflexes in the biceps (C5), brachioradialis (C6), triceps (C7), and the first dorsal interosseous muscles (C8). ResultsSimultaneous regression analyses yielded clinically useful upper limits of normative values for latencies, side-to-side differences, and amplitude ratios adjusted to age and arm span. Comparison of the T reflexes between the 2 sides localized the solitary root lesions with a high sensitivity (92%), specificity (81%), and accuracy (83%). T-reflex studies proved helpful to localize the lesion even in patients who solely complained of upper limb pain. ConclusionsThe T reflexes with a standardized facilitation of the upper limb muscles provide a clinically useful, noninvasive measure to localize the C5 to C8 radiculopathies. This study contributes in reassessing the currently underused T reflex as an electrodiagnostic technique.