Secrets of the Jedi Masters

Today I am going to reveal one of the deep, dark secrets of neurology. A secret so carefully hidden that this post could result in my excommunication from the neurobrotherhood.

Most doctors, in some way, are snobs. Some are money snobs (a malady not limited to medicine), others about where they went to med school, still others about their clientele, others about research.

And what are neurologists snobs about?

We are snobs about...

(looks around furtively and whispers)

Reflex hammers.

Yes, reflex hammers. The little rubber triangular thing your internist uses to tap on your knees.

But we're NEUROLOGISTS, damnit! We did 3 years of training to learn how to properly use a reflex hammer! Plus, while your internist will only tap on your knees, we have a bunch of other reflexes we check.

I mean, we have to do SOMETHING to make it worth your higher co-pay to see a specialist. Would Harry Potter carry around just any old wand? No! Reflex hammers are to neurologists as lightsabers are to Jedi.

This is what your internist likely uses:





It's called a Taylor hammer. Or Tomahawk. They give you one in med school. No self-respecting neurologist would EVER be seen holding one. It's like a toy to us, and we are specially trained to look down our noses at them with a "you call THAT a reflex hammer!" look.

Someone once pointed out to me that this was one of the very first types of reflex hammer specially designed for this purpose. My answer to that is that the Wright brother's plane was the first one built, but I don't see anyone catching one to Chicago these days, either.

The only thing (in the eyes of a neurologist) lower than a Taylor hammer is this bizarre contraption:




Yes, it's a sad attempt to combine a Taylor hammer and a tuning fork (another item commonly used by neurologists). In the Bible they called things like this "abominations unto the Lord" (or, in our case, abominations unto Charcot).

It's like a sofa-bed: when you combine 2 things, you often get something that isn't quite as good as either one alone. When I was in med school I thought these things looked cool and practical (it took up less pocket space in that stupid looking short white coat). Now that I'm a neurologist, I realize how worthless they are. If you ever have a neurologist use one on you, ask them how many box tops they had to exchange for their medical degree.

The only thing worse than either of the above is using the head of your stethoscope to check reflexes. Might as well put on a shirt that says "Beware! Greenhorn on rounds!"

Next up, and maybe a notch or 2 above the Taylor hammer:

This is a Buck hammer.



The Buck is a few notches above the Taylor. It means that you're somewhat serious about checking reflexes. It's often carried by neurologists on hospital rounds, because it's convenient to toss in your bag.

A word of warning- the top piece on most Buck's unscrews to reveal a sharp pin. This is a throwback to the pre-AIDS era when you could freely jab multiple patients with the same sharp object and not worry about spreading disease. If your doctor pulls one out of his hammer and tries to jab you with it, RUN AWAY. You don't know where it's been.

A few rungs up, and we get the Trömner hammer (or Troemner, depending on where you trained).



Now THIS is a good hammer. It's what I carry in my hospital bag. The picture alone can't convey what it feels like to hold one. Although it looks somewhat like a Buck hammer, in reality it's larger and heavier. It has a solid, reassuring, feel to it, like if the patient suddenly lunges, you can beat the crap out of him with it. No other reflex hammer gives you that sense of security.

For my pharmacy readers, my faithful Trömner actually was a gift from a Naprosyn rep. Which says more about me than I want to admit.

This is a Berliner hammer. I've never used this type.



It looks, somewhat reassuringly, like an axe (to keep the Haldol deprived at bay until the orderlies arrive).

Now we come to the royalty of reflex testing, the Queen Square hammer.



As simple as it looks, this is THE HAMMER for the serious neurologist. It's what I (and most) keep in our offices. It's nicely weighted and allows you to swing it easily from several directions to test reflexes in different limbs, without having to reposition yourself or the patient too much. It's not as solid as the Trömner, but if the patient attacks you can stun them with it (it breaks after 1 solid hit, don't ask how I know this) as you draw your other hammer.

But neurologists sometimes have to round at the hospital, and the Queen Square, with it's long stalk, doesn't conveniently fit in a black bag. So, if you don't like the Trömner or Buck, there's the Babinski hammer.



This is basically the smaller handle of a Buck hammer with the Queen Square head. The head usually tilts to the side and the handle telescopes to a smaller size so you can put it in your bag.

It has the bizarre history of having been introduced to the U.S. by neurologist Abraham Rabiner, who received his personally from the great Dr. Babinski himself. This was as a peace offering after the 2 of them had physically beaten the shit out of each other (REALLY!) during a debate over a neurophysiology question at a Vienna black-tie dinner (Hey, we neuro Jedi take this shit seriously).

There are a handful of other hammer types out there (Krauss, Wintrich, Ebstein, and Wintle to name a few), mostly variants of the above. Some of them, like Ebstein and Wintrich, are of mostly historical interest and no longer used.

That's reflex hammers in a nutshell. Now you have something to talk about when you want to see a neurologist, or pretend to be a neurologist, or want to score points on your neurology rotation, or end up on Jeopardy saying "I'll take 'Reflex Hammers' for $500, Alex."

And know, ye of lesser hammers, why those of us who wield a Trömner or Queen Square look down on you as unwashed heathens. And appropriately so.