Positioning and General Management of Upper Limbs in Spinal Cord Injury

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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. Increase and/or maintain range of motion
  2. Prevent and/or decrease upper limb (UL) pain
  3. Prevent UL injury

Positioning in Supine[edit | edit source]

Shoulders

  • In open positon
  • Externally rotated
  • Scapula "pulled back"

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]

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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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