Does your neurologist tap your reflexes? What is the history of the hammer?

DOUG LANSKA’S 1989 ARTICLE ON REFLEX HAMMERS IN NEUROLOGY IS A SEMINAL PAPER ON THE TOPIC.

Doug Lanska, a number of years ago, wrote what I think will stand as a seminal review (in the journal Neurology) of all of the “reflex hammers” used in the practice of clinical neurology.

The Stanford Neurology website reviews neurological reflexes in this nice video.

A reflex tells a neurologist there is something potentially wrong with the nervous system and the examination helps to localize the issue. “A reflex arc is the pathway that a nerve reflex, such as the knee jerk reflex, follows. A tap on the knee stimulates sensory receptors, generating a nerve signal. The signal travels along a nerve to the spinal cord. In the spinal cord, the signal is transmitted from the sensory nerve to a motor nerve.” - a nice description from the Merck manual.

Here are a few of my favorite points (MSO) from this article by Lanska which offers the cool history of reflex hammers.

Gowers suggested you could use a “karate chop” or a hammer to elicit the patellar reflex.

The Wintrich reflex hammer was the first popular reflex hammer in neurology in 1854 and it also had the added feature of a tool embedded in it to test the sensation (Ebstein modification 1912).

The Taylor hammer in 1904 quickly became the most popular hammer for testing reflexes. Later the American Academy of Neurology added a version that had a tuning fork built in to the hammer.

Christopher Krauss showed off his reflex hammer that also tested sensation at the 20th annual AAN meeting in 1894.

The Troemner reflex hammer in 1910 was the one preferred by the neurology attendings who trained me. They claimed they liked it because it was “heavier.”

Following a heated discussion with some level of physical altercation, Dr. Babinski gifted Dr. Rabiner this hammer. Rabiner was annoyed that Babinski had no physiological explanation for his toe reflex.

Finally we reach the Queen Square hammer. This hammer is said to have been modified from a chest percussion hammer of Henry Vernon in 1858.