7/13/2021 Monosynaptic Reflex - StatPearls - NCBI Bookshelf

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Monosynaptic Reflex
Authors

Aaron D. Walkowski1; Sunil Munakomi2.

Affiliations
1 Lake Erie College of Osteopathic Med
2 Kathmandu University

Last Update: February 8, 2021.

Definition/Introduction
The monosynaptic stretch reflex, or sometimes also referred to as the muscle stretch reflex, deep tendon reflex, is a
reflex arc that provides direct communication between sensory and motor neurons innervating the muscle. This reflex
begins inside the muscle spindle of the muscle, which detects both the amount and rate of muscle stretch. When the
muscle experiences a stretch stimulus, sensory impulses are transmitted from the muscle spindle via Ia afferent fibers
to the dorsal root of the spinal cord. Once in the dorsal horn of the gray matter of the spinal cord, the fiber synapses
on the corresponding alpha motor neuron in the ventral horn of the spinal cord. This alpha efferent fiber then exits
through the ventral root and courses back sends an action potential to the neuromuscular junction of the original
muscle that initiated the reflex to the synapse to cause contraction. This contraction allows the muscle to resist the
force that initially caused the reflex. In contrast, the polysynaptic stretch reflex involves a single sensory stimulus that
synapses on interneurons within the spinal cord gray matter, which allows communication to multiple muscles for
contraction or inhibition.[1][2]

Clinical Significance
These reflexes are graded on a scale from 0 to 4+, where 0 is absent, 2+ is normal, and 4+ indicates hyperactivity
wherein a tap elicits a repeating reflex (clonus). Grading these reflexes is important because abnormalities can often
indicate that a reflex arc has been affected, which could mean a problem could involve the sensory fiber, the spinal
cord, or the motor fiber. If a lesion involves the anterior horn of the spinal cord at that level or the motor fiber itself,
then it would be defined as a lower motor neuron lesion (LMN). These lesions result in decreased reflexes (grade 0 to
1) due to damage to the alpha motor neurons. If the lesions involve the cerebral cortex, brain stem, or descending
motor tracts, then they are upper motor neuron lesions (UMN). These lesions result in increased reflexes (grades 3 to
4) due to the loss of inhibition from the descending motor pathways.[3]

The Hoffman, or 'H reflex,' is similar to the muscle stretch reflex and is obtained after the selective electrical
stimulation of the sensory 1a afferents, bypassing the muscle spindles.[4]

Higher stimulation should be avoided as it may cause 'F wave' owing to the stimulation of the alpha fibers.

Golgi tendon organs outplay inverse myotatic reflex mediating through the 1b afferents and gamma efferents. This
checks sustained tonic contraction following stretch reflex by inhibiting the agonist (inhibitory postsynaptic
potentials) and stimulating the corresponding group of antagonists'  muscles (summations of excitatory postsynaptic
potentials). Any abnormality in this mechanism leads to hyperexcitable stretch reflexes, thereby causing spasticity.[5]

Nursing, Allied Health, and Interprofessional Team Interventions

Under normal circumstances, the monosynaptic reflex is an inducible action, rather than a pathology. However,
patients can present with abnormal DTRs from a variety of causes. When pathologic, the monosynaptic reflex can
provide insight towards an underlying neurological dysfunction; this could indicate a wide variety of etiologies
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7/13/2021 Monosynaptic Reflex - StatPearls - NCBI Bookshelf

ranging from a spinal cord lesion to an electrolyte imbalance. Thus, identifying or determining the cause of the
abnormal reflex could involve many members of the healthcare team and could improve treatment strategies and
management.[6] [Level 1]

Assessing, discovering, and communicating the presence of an abnormal reflex can enhance patient outcomes, safety,
and care. Coordination and communication within the healthcare team of a patient are essential to patient-centered
care.[7]

Continuing Education / Review Questions

Access free multiple choice questions on this topic.

Comment on this article.

References
1. PERL ER. A comparison of monosynaptic and polysynaptic reflex responses from individual flexor
motoneurones. J Physiol. 1962 Dec;164:430-49. [PMC free article: PMC1359243] [PubMed: 13942459]
2. Héroux ME. Tap, tap, who's there? It's localized muscle activity elicited by the human stretch reflex. J Physiol.
2017 Jul 15;595(14):4575. [PMC free article: PMC5509851] [PubMed: 28542785]
3. Iles JF, Roberts RC. Inhibition of monosynaptic reflexes in the human lower limb. J Physiol. 1987 Apr;385:69-87.
[PMC free article: PMC1192337] [PubMed: 2958622]
4. Palmieri RM, Ingersoll CD, Hoffman MA. The hoffmann reflex: methodologic considerations and applications for
use in sports medicine and athletic training research. J Athl Train. 2004 Jul;39(3):268-77. [PMC free article:
PMC522151] [PubMed: 16558683]
5. Thompson AJ, Jarrett L, Lockley L, Marsden J, Stevenson VL. Clinical management of spasticity. J Neurol
Neurosurg Psychiatry. 2005 Apr;76(4):459-63. [PMC free article: PMC1739594] [PubMed: 15774425]
6. Jensen G, Bar-On E, Wiedler JT, Hautz SC, Veen H, Kay AR, Norton I, Gosselin RA, von Schreeb J. Improving
Management of Limb Injuries in Disasters and Conflicts. Prehosp Disaster Med. 2019 Jun;34(3):330-334.
[PubMed: 31025618]
7. Sanderson A, West DJ. A Model for Sustaining Health at the Primary Care Level. Hosp Top. 2019 Apr-
Jun;97(2):46-53. [PubMed: 31025907]

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