Upper Limb Management in Lower Tetraplegia and Central Cord Syndrome

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Introduction[edit | edit source]

Upper limb function is a key element in regaining autonomy for patients with a cervical spinal cord injury. A conservative treatment may transition into a surgical pathway, and treatment strategy is based on the type of damage present (upper vs lower motor neuron). It includes positioning, splinting, passive and active range of motion, functional training, and training with adaptive equipment with aim to offer the best possible benefit to the individual patient.[1]Prevention must be considered when treatment strategies are selected. Claw hands, contractures, or inadequate closing or opening of the fingers may occur as a result of lower level cervical spinal cord injury.[1]This article will discuss upper limb function with lower level cervical spinal cord injury and its impact on the patient's functional abilities.

C6 Tetraplegia[edit | edit source]

  1. Innervated upper limb muscles
    • Deltoid, biceps, brachialis, brachioradialis (C5 level)
    • Pectoralis (clavicular head only)
    • Supinator
    • Radial wrist extensors (extensor carpi radialis longus and/or brevis)
  2. No elbow extension
  3. No active movements of fingers or thumbs
  4. Functional impact
    • Unable to raise arms above shoulder level without external rotation
    • Potential for tenodesis grip
    • Able to extend wrist, rotate and adduct the shoulder[2]
    • Improved weight bearing through the upper limbs due to the function of latissimus dorsi and pectoralis

Goals for upper limb(UL) management:

C7 Tetraplegia[edit | edit source]

  1. Innervated upper limb muscles
    1. All muscles at C6 level
    2. Pectoralis (sternal head)
    3. Triceps
    4. Pronator teres
    5. Flexor carpi radialis (wrist flexor)
    6. Extensor digitorum communis (finger extensor)
  2. Weak fingers and/or thumb extension may be present
  3. No fingers and thumb flexion
  4. Functional impact
    1. Able to lift arms above shoulder level
    2. Potential for tenodesis grip

C8 Tetraplegia[edit | edit source]

Central Cord Syndrome[edit | edit source]

Resources[edit | edit source]

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References[edit | edit source]

  1. ↑ 1.0 1.1 Bersch I, Krebs J, Fridén J. A Prediction Model for Various Treatment Pathways of Upper Extremity in Tetraplegia. Front Rehabil Sci. 2022 Jun 30;3:889577.
  2. ↑ Oelofse W. Upper Limb Management in Lower Tetraplegia  - Occupational Therapy Course. Plus 2022
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