The DTR medical abbreviation stands for deep tendon reflex, the quick automatic jerk of a muscle when a clinician taps its tendon with a small rubber hammer. In the plural, DTRs means the set of reflexes checked during a neurological exam.
You will usually find it in the neuro part of a physical exam, usually paired with a grade like 2+ and a word like symmetric. Patients spot it in visit summaries after a back, neck or nerve complaint, and students learn it early in health assessment class. This page explains the grading scale, which tendons get tapped, and how to read a reflex line in a real chart.
At a glance
Stands for
Deep tendon reflex (DTRs for more than one)Other meanings
Dietetic technician, registered, a nutrition credentialWritten as
DTR, DTRs, dtrGraded on
A scale of 0 to 4+, with 2+ the usual normalWhere you see it
Neuro section of a physical exam or H&PDo not confuse with
What the DTR medical abbreviation describes
A deep tendon reflex is a loop between a muscle, the spinal cord and back again. When the tendon is tapped, the muscle stretches slightly, a sensory nerve sends a signal to the spinal cord, and a motor nerve fires the muscle back without the brain having to decide anything. The knee jerk is the one most people know.
Because the loop runs through specific nerve roots, checking DTRs helps a clinician see whether nerves, the spinal cord or the brain may be affected. A reflex that is missing, weak, very brisk or different from one side to the other gives a clue about where to look next. The result is one small piece of a full exam, never a diagnosis on its own.
The reflex grading scale
Most US charts use a five step scale. The plus sign is part of the grade, so 2+ is read as two plus.
| Grade | Plain meaning |
|---|---|
| 0 | No reflex seen, even with reinforcement |
| 1+ | Present but reduced, sometimes called hypoactive |
| 2+ | Normal, the expected response |
| 3+ | Brisker than average; can be normal in some people |
| 4+ | Very brisk, often with clonus, repeated beats of the muscle |
A 1+ or 3+ grade on both sides can be a normal variation for that person. Clinicians pay more attention when the grade differs between left and right, or when it changes over time.
Which tendons get tapped
A routine exam usually checks five reflexes on each side. Each one is linked with particular spinal nerve roots.
- Biceps, at the inside of the elbow
- Brachioradialis, on the thumb side of the forearm
- Triceps, just above the back of the elbow
- Patellar, the knee jerk, below the kneecap
- Achilles, the ankle jerk, at the back of the heel
Handwritten notes sometimes show a stick figure with a grade at each joint, so a line like dtr 2 plus at every joint is the common normal picture. Typed notes may list them one by one, for example patellar 3+ on the right.
Reading DTRs in a real exam note
Clinic note: "DTRs 2+ and symmetric in upper and lower extremities. Toes downgoing." Every reflex tested was normal and the same on both sides. Toes downgoing refers to a separate sole test, where curling the toes down is the expected adult result.
Emergency note: "Achilles reflex 1+ on the left, 2+ on the right." The left ankle jerk was weaker than the right. A clinician would read this together with symptoms such as back pain or numbness, not alone.
Hyporeflexia means reduced reflexes and hyperreflexia means increased ones. Pupil findings such as PERRLA often sit in the same exam. You may also see the words with reinforcement, which means the patient clenched their teeth or pulled their hands apart to make a faint reflex easier to bring out.
Other meanings of DTR
Outside the exam room, DTR also names a nutrition credential: dietetic technician, registered. It shows up after a person's name on a badge or in a care team list, often written NDTR when the nutrition part is added. Context settles it almost every time, since a credential sits beside a name and a reflex sits beside a grade or a body part.
Tips for students charting reflexes
When you document DTRs, record the grade for each side and say whether they match. Write the reflex name if any result is abnormal, and note clonus by counting beats if present.
Reflex lines usually sit near other neuro shorthand. A good next read is the chart notes and nursing abbreviations guide, which sorts exam shorthand alongside history and vital sign terms. Terms like WNL often appear in the same paragraph.
Reflex grades are one detail among many in an exam. If a grade in your record worries you, your own clinician can explain what it means in the context of your visit.
Frequently asked questions
What does DTR 2+ mean?
It means the deep tendon reflex was normal. On the usual 0 to 4+ scale, 2+ is the expected response for most adults.
What do DTRs stand for in a medical note?
DTRs stands for deep tendon reflexes, the reflexes tested by tapping tendons such as those at the knee, ankle and elbow. The plural form is used when several are reported together.
Is a 3+ reflex abnormal?
Not always. Some healthy people have brisk reflexes on both sides. Clinicians look at whether both sides match, whether there is clonus, and what else the exam shows.
What does absent DTR mean?
A grade of 0 means no reflex could be seen, even with reinforcement. It has many possible causes, so the clinician who did the exam is the right person to explain it.
Is DTR the same as reflexes WNL?
They overlap. DTRs names the specific reflexes, while WNL means within normal limits. A note might say DTRs WNL instead of giving a grade, though many teachers prefer the number.