A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; furthermore:
- Inspection (viewing) of the skin and mucous membranes.
- Auscultation (listening) of the heart
- Auscultation of the lungs
- Palpation (palpation) of the abdomen (abdomen), etc.
- Neurological examination – including examination of motor function, sensitivity, coordination and cranial nerve function.
Pathological reflexes, implementation and interpretation
| Name of the reflex | Implementation | Interpretation |
| Babinski sign(synonyms: big toe reflex, toe reflex, Babinksi reflex). | Stroking the lateral (side) sole of the foot causes spreading of toes 2-5 and dorsiflexion of the big toe | Pyramidal trajectory sign; still physiological (“natural” or age-appropriate) in infants up to about one year of age |
| Chaddock sign(synonym: Chaddock reflex). | Stroking the lateral dorsum of the foot causes toes 2-5 to spread and the big toe to dorsiflex (bend toward the dorsum of the foot) | Pyramidal trajectory sign |
| Gordon sign(synonyms: toe sign, Gordon sharp reflex, calf reflex). | Kneading of the calf leads to spreading of toes 2-5 and dorsiflexion of the big toe | Uncertain pyramidal trajectory sign; represents a modification of the Babinski reflex |
| Léri forearm sign | Passive finger/hand flexion leads to flexion synergy in the elbow joint | Pyramidal trajectory sign; co-movement of elbow is physiologic; unilateral attenuation is pathologic (pathological) |
| Marie-Foix/Gonda sign(synonym: Marie-Foix sign). | Passive flexion of the toes leads to flexion synergy in the knee and hip joints | Pyramidal trajectory sign |
| Mayer finger base joint reflex | Complete passive flexion (bending) of fingers 4 and 5 leads to tonic adduction (lateral approach to the body or limb axis) of the thumb; here, the lateral difference is crucial | Failure of the reflex indicates damage to the nerves of the hand or damage to the pyramidal tract |
| Mendel-Bechterew sign (synonym: Mendel reflex). | Tapping of the lateral dorsum of the foot causes splaying of toes 2-5 and dorsiflexion of the great toe | Pyramidal trajectory sign |
| Monakov sign | Stroking the lateral edge of the foot leads to elevation of the lateral edge of the foot | Pyramid trajectory sign |
| Oppenheim sign (synonym: Oppenheim reflex) | Brushing the anterior edge of the tibia distally with the knuckles causes spreading of toes 2-5 and dorsiflexion of the great toe | Pyramidal trajectory sign; is a modification of the Babinski reflex |
| Strümpell sign or Clauß sign | Active knee flexion of the patient against the pull of the examiner results in dorsiflexion of the great toe and supination of the foot (elevation of the inner edge of the foot while lowering the outer) | Pyramidal tract sign indicating damage to central motoneurons (nerve cell of the central nervous system that exerts direct or indirect control over a muscle with its axon.) |
| Wartenberg thumb sign | Traction on finger end phalanges 2-5 results in tonic thumb flexion and thumb adduction | Pyramidal trajectory sign |
Pyramidal tract signs are neurological symptoms/reflexes that are pathological (pathological) in adults and are clustered when there is a lesion (damage) to the pyramidal tract. In infants, the phenomena are physiologic because the pyramidal tracts are not yet mature.
