Abstract
Objective: To examine the origins and evolution of the reflex hammer and its incorporation into neurological clinical practice.
Background: The reflex hammer is an important diagnostic tool used by physicians to test deep tendon reflexes, an essential part of the neurological physical examination in order to assess the peripheral and central nervous system.
Design/Methods: Literature review primarily through PubMed and historical archives.
Results: There are three important milestones leading to the incorporation of the reflex hammer into clinical practice: the discovery of percussion, the description of the clinical usefulness of deep tendon reflexes, and the construction of the first neurological reflex hammer. The reflex hammer found its origins in a wine-growers’ tool used to thump the wine casks in order to measure the amount of wine inside. Based on this practice, Austrian physician Leonard Auenbrugger first described thoracic percussion in 1761. By 1826, percussion had entered clinical practice in mainland Europe and “percussion hammers” were developed and carried by physicians. An important catalyst were the scientific publications by Heinrich Erb and Carl Westphal in 1875 describing the patellar reflex and its implications for diagnosing neurological disease. These papers boosted scientific interest in deep tendon reflexes and the best way to elicit them. In order to assess the reflexes, physicians initially used their hands (“finger taps” or “side hand taps”) and their percussion hammers. However, these were inadequate to reliably elicit the response. It wasn’t until 1888 that the first neurological reflex hammer was developed by John Madison Taylor in Philadelphia, PA. Over the next decades, the reflex hammer continued to evolve and new designs surfaced.
Conclusions: In the face of modern diagnostic and imaging technology, the reflex hammer is a diagnostic tool that continues to evolve and hold its place in history and clinical practice.
Disclosure: Dr. Sisniega has nothing to disclose.
Letters: Rapid online correspondence
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