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International Journal of Neuroscience

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MIDDLE-FINGER REFLEX
Üner Tan a
a
Department of Physiology, Çukurova University Medical School, Adana, Turkey

Online Publication Date: 01 June 2006

To cite this Article Tan, Üner(2006)'MIDDLE-FINGER REFLEX',International Journal of Neuroscience,116:5,541 — 545

To link to this Article: DOI: 10.1080/00207450500403306
URL: http://dx.doi.org/10.1080/00207450500403306

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 Intern. J. Neuroscience, 116:541–545, 2006
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ISSN: 0020-7454 / 1543-5245 online

DOI: 10.1080/00207450500403306

Brief Report

MIDDLE-FINGER REFLEX

ÜNER TAN
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Department of Physiology
Çukurova University
Medical School
Adana, Turkey

A new reflex is described: middle-finger extensor reflex elicited by percussion of

tendon insertion of musculus extensor digitorum communis in forearm. Following
percussion using a reflex hammer, two EMG responses from the belly of the muscle
were recorded: a short latency monosynaptic reflex with a latency of 31.4 ± 1.5 ms
(M1), and a long-latency middle-finger reflex with a mean latency of 64.8 ± 6.31 ms
(M2), the former being a monosynaptic extensor reflex, and the latter belonging to a
spino-cortico-spinal reflex circuitry. It was suggested that the middle-finger extensor
reflex elicited by radial nerve afferents and efferents (C7–C8) would be of clinical
and theoretical importance.

Keywords extensor, long-latency reflex, middle finger, reflex, short-latency reflex

As a medicine student in Aegean University (Izmir, Turkiye) in 1956 the author

discovered a new reflex. This was an extensor middle-finger reflex elicited by
percussion with a reflex hammer of the tendon of musculus extensor digitorum
communis. The reflex could be produced in all healthy individuals without
exception, in contrast to mostly examined patella reflex. The middle-finger ex-
tensor reflex can be used in every clinical examination in addition to traditional
reflexes such as patella reflex, Achilles reflex, biceps reflex, and so on.

Received 9 February 2005.

Address correspondence to Prof. Dr. Üner Tan, Department of Physiology, Medical School,
Çukurova University, Adana, 01330 Turkey. E-mail: unertan@cu.edu.tr

541
 542 Ü. TAN

Figure 1. Musculus extensor digitorum communis (from Vesalius, Fabricus, 1543). (See Color
Plate I at end of issue.)

Musculus extensor digitorum communis is mainly responsible for exten-

sion of three digits (2nd, 3rd, and 4th) of hands. The fifth finger is extended
by extensor digiti minimi (quinti) muscle. MEDC is innervated by a branch of
radial nerve (C7–C8). In 1543, Vesalius described this muscle in “Fabricus” as
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the main extensor for four digits (see Figure 1).

Merram-Webster’s Medical Dictionary (2002) describes MEDC as “a
muscle on the back of the forearm that extends the fingers and wrist.”
The extensor middle-finger reflex can be elicited by percussion of MEDC
tendon proximally. As a monosynaptic stretch-reflex response, only the middle
finger extends, if a proper point can be found. Method is illustrated in Figure 2.
In a healthy participant, percussion of the MEDC tendon elicited extension only
in middle finger (see Figure 2A and B). There was, however, a pathological
middle-finger reflex in the left arm of the Author (see Figure 2B and C): the
reflex response persisted for about 5 s following percussion of MEDC tendon
(delayed relaxation of the middle-finger reflex).
Percussion of MEDC tendon usually elicited two reflex responses in
electromyographic (EMG) activity: a short-latency monosynaptic reflex and
a long-latency polysynaptic reflex response. These are illustrated in Figure 3.
The mean latency of the short-latency component (M1) was 31.48 ± 1.49 ms
(n = 44), whereas the mean latency of the long-latency component (M2) was
64.81 ± 6.31 ms (n = 41).
The short-latency middle-finger reflex response (M1) may be elicited by
group Ia afferents from muscle spindles during stretch of MEDC following
percussion of its tendon. The long-latency component (M2) may be a spino-
cortico-spinal reflex. M1 and M2 responses were indeed recorded during
rapidly imposed joint angular displacements of the stretched muscle groups
(Hammond, 1954). The M1 response is appropriate to be largely mediated by
monosynaptic input from group Ia muscle-spindle afferents (Tatton & Lee,
1975). The M2 response elicited in the distal muscles of the upper limb is pre-
dominantly mediated by a transcortical pathway through the contralateral pri-
mary motor cortex (Lee & Tatton, 1975; Tatton et al., 1975; Marsden et al., 1977;
 MIDDLE-FINGER REFLEX 543
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Figure 2. Eliciting middle-finger reflex by a reflex hammer in a participant (A and B). A and B:
before and during percussion of MEDC tendon. B and C: before and after percussion of the tendon
of MEDC in the left hand of author (U.T.). Notice the persistence of middle-finger extensor reflex
in this participant exhibiting a pathological reflex phenomenon. (See Color Plate II at end of issue.)

Figure 3. EMG response following percussion of MEDC in a participant. The first deflection is
mechanical artefact caused by percussion of the muscle tendon. The following potentials are M1
and M2 responses. Abscissa: time (s); ordinate: amplitude (mV).
 544 Ü. TAN

Wiesendanger & Miles, 1982). MacKinnon et al. (2000) have recently reported
that rapid angular extensor displacements of the right wrist generates M1 and
M2 responses in flexor carpi radialis muscle; the mean onset latencies were
found to be 32 ± 2 and 60 ± 5 ms, respectively. These are consistent with
the latency measurements (see earlier). MacKinnon et al. (2000) interpreted
these results as suggesting a transcortical reflex circuitry originating from wrist
extensors.
An isolated stretch reflex in middle finger may be strange at first
glance, because it is generally thought that MEDC originates proximally
from the lateral epicondyle extending all of three or four fingers. Fairbank
and Corlett (2002) have, however, found that only the muscle segment for
the middle finger originated proximally from the lateral epicondyle (beneath
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the percussion point for the middle-finger reflex). The other segments of
MEDC attached more distally to surrounding muscles. These results explain
how an isolated middle-finger reflex can be elicited by percussion of EDC
muscle.
Examination of middle-finger reflex may have important clinical and
theoretical implications with regard to monosynaptic and spino-cortico-spinal
reflex acitivites. The extensor middle-finger reflex can be easily elicited in
everyone in contrast to other mostly used stretch reflexes. EMG activity
elicited during middle-finger reflex may show two important reflex components
(M1 and M2), which may be of importance for diagnostic and therapeutic
applications as well as for the normal functioning of peripheral and central
nervous system.

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Fairbank, S. M., & Corlett, R. J. (2002). The role of the extensor digitorum communis
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 MIDDLE-FINGER REFLEX 545

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