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The reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions. There are five deep tendon reflexes and a number of superficial and visceral reflexes covered here. the anal wink reflex is elicited by gently stroking the perianal skin with a safety pin. It results in puckering of the rectal orifice owing to contraction of the corrugator-cutis-ani muscle. The best known of this group of reflexes is the plantar reflex. The next step of the rectal examination involves the assessment of neuromuscular integrity. First, each side of the buttocks is scratched with the gloved finger to elicit the superficial anal reflex (the anal wink), a function of l 1 and l 2. a reaction of the external anal sphincter muscle when the adjacent skin is briefly and briskly stimulated. A normal reflex is a contraction of the sphincter also known as anal wink. to test sphincteric tone (s2 to s4 nerve root levels), the examiner inserts a gloved finger into the rectum and asks the patient to squeeze it. Alternatively, the perianal region is touched lightly with a cotton wisp the normal response is contraction of the external anal sphincter (anal wink reflex). examine the anus for the presence of any fissures, fistulae, or hemorrhoids. To elicit an anal wink, stroke the perianal skin with a pin or probe. This page includes the following topics and synonyms reflex exam, tendon reflex, deep tendon reflex, pectoral reflex, deltoid reflex, biceps reflex, brachioradialis reflex, supinator reflex, triceps reflex, patellar reflex, knee jerk, medial hamstring reflex, achilles reflex, ankle jerk, anal wink.