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]

Upper Limb 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 [3][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

  • Position in the opposition to maintain the web space
  • Night splint vs hand resting splint at night, or
  • Rolled-up towel placed in the web space to maintain the web space.
  • Position the hands higher than the shoulders to prevent gravitational swelling

Positioning in Sitting[edit | edit source]

A wheelchair sitting posture of a person with cervical level spinal cord injury is often characterised by:

  • rounded shoulders with increased thoracic kyphosis
  • tendency to progress to more slouched posture throughout the day
  • forward head posture
  • reliance on the upper extremities to maintain balance


adequate support for the weight of the upper limb

Upper Limb Stretching and Strengthening Programs[edit | edit source]

Stretching[edit | edit source]

Strengthening[edit | edit source]

Tenodesis Grasp[edit | edit source]

Upper Limb 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.
  3. ↑ Oelofse W. Positioning and General Management of Spinal Cord Injury - Occupational Therapy Course. Plus 2022
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