Positioning and General Management of Upper Limbs in Spinal Cord Injury: Difference between revisions

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Goals:
Goals:


# Increase and/or maintain range of motion
# To increase and/or maintain range of motion
# Prevent and/or decrease upper limb (UL) pain
# To prevent and/or decrease upper limb (UL) pain
# Prevent UL injury
# To prevent UL injury


=== Positioning in Supine ===
=== Positioning in Supine ===
'''Shoulders'''
'''Shoulders'''


* In open positon
* Crucifix position with shoulders in external rotation. Avoid extreme position and use progression ("serial positioning) to reach end range and eliminate stressing the tissue
* Externally rotated
 
* In open position
* Some shoulder abduction and external rotation, with positions alteration as needed
* Shoulders in a mid-position or in slight protraction
* Scapula "pulled back"
* Scapula "pulled back"
'''Elbows'''
* Extension, but not hyperextension.
* With overactive biceps maintain extension of the elbow using a soft splint, a vacuum splint, or a pillow wrapped around the forearm.
'''Wrist'''
* Extension or dorsiflexion up to 45 degrees
* Appropriate position maintained using the splint, or the pillow
'''Thumb'''
* We want it opposed. So, we want this position of the thumb. We don't want the thumb next to the fingers. So, we want to maintain the web space, open up the web space, and again, it's through splinting. So, they can wear night splints during the evening, hand resting splint at night. But even if you just add a roll or put a roll between those fingers and the roll could be a rolled-up towel that you can put there in the web space to maintain the web space. When you position the arms, we want to, generally, position the hands higher than the shoulders to prevent gravitational swelling.
*  
*  


Revision as of 20:07, 30 November 2022

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Introduction[edit | edit source]

Range of motion (ROM) limitations and joints contracture can significantly limit functional abilities in patients with a spinal cord injury. Shoulder ROM problems are related to functional limitations, disability, and perceived health. In addition patients with tetraplegia can suffer from upper limb spasticity which is reported to be one of the most difficult health complications after SCI.[1][2]These complications include restriction in activities of daily living (ADLs), pain and fatigue, sleep disturbance, and safety, leading to the development of contractures, pressure ulcers, infections, and negative self-image. [2]This article will discuss therapeutic strategies including appropriate positioning, stretching, strengthening, the tenodesis grasp and spasticity management which can help to maintain range of motion and facilitate function.

Maintaining Range of motion[edit | edit source]

Positioning[edit | edit source]

Goals:

  1. To increase and/or maintain range of motion
  2. To prevent and/or decrease upper limb (UL) pain
  3. To prevent UL injury

Positioning in Supine[edit | edit source]

Shoulders

  • Crucifix position with shoulders in external rotation. Avoid extreme position and use progression ("serial positioning) to reach end range and eliminate stressing the tissue
  • In open position
  • Some shoulder abduction and external rotation, with positions alteration as needed
  • Shoulders in a mid-position or in slight protraction
  • Scapula "pulled back"

Elbows

  • Extension, but not hyperextension.
  • With overactive biceps maintain extension of the elbow using a soft splint, a vacuum splint, or a pillow wrapped around the forearm.

Wrist

  • Extension or dorsiflexion up to 45 degrees
  • Appropriate position maintained using the splint, or the pillow

Thumb

  • We want it opposed. So, we want this position of the thumb. We don't want the thumb next to the fingers. So, we want to maintain the web space, open up the web space, and again, it's through splinting. So, they can wear night splints during the evening, hand resting splint at night. But even if you just add a roll or put a roll between those fingers and the roll could be a rolled-up towel that you can put there in the web space to maintain the web space. When you position the arms, we want to, generally, position the hands higher than the shoulders to prevent gravitational swelling.

Positioning in Sitting[edit | edit source]

Stretching and Strengthening Programs[edit | edit source]

Stretching[edit | edit source]

Strengthening[edit | edit source]

Tenodesis Grasp[edit | edit source]

Spasticity Management[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ Reinholdt C, Fridén J. Selective release of the digital extensor hood to reduce intrinsic tightness in tetraplegia. Journal of Plastic Surgery and Hand Surgery. 2011 Apr 1;45(2):83-9.
  2. ↑ 2.0 2.1 Saxena A, Sehgal S, Jangra MK. Effectiveness of Neurodynamic Mobilization versus Conventional Therapy on Spasticity Reduction and Upper Limb Function in Tetraplegic Patients. Asian Spine J. 2021 Aug;15(4):498-503.
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