The Hip: Preservation, Replacement and Revision

C6 Neurologic Level: (C5-C6 disk)

- Radiculopathy:
    - pts with a C6 radiculopathy should cause pain in the neck, shoulder, lateral arm, radial forearm, dorsum of hand, and tips of thumb, index, and long finger;
    - distribution of pain is less extensive and more proximal, whereas paresthesia's predominate distally;
    - in some individuals, a C6 lesion will manifest as a depressed or absent biceps reflex;
           - in others, an abnormal brachioradialis or wrist extensor reflex can be found;
    - C6 root lesions should be distinguished from lesions of brachial plexus;
           - elbow flexion will be weak, and the patient will be unable to supinate the forearm against resistance with the elbow held in extension;

- C6 Quadriplegic Considerations:  (care of the spine injured patient)
    - pts w/ C-6 functional level can become independent because wrist extensor muscle function is still intact.
         - pts may engage in independent living and perform independent sliding board transfers from bed to chair
                and will be able to propel a manual wheelchair w/ quadriplegic pegs on wheel rim;
         - pts should be able to perform self hygiene and feeding;
    - in C6 lesions, radial wrist extension & varying degrees of triceps (C6-8) function is preserved;
    - major concern in these patients is prevention of flexion contractures at elbow to the unopposed action of the flexor muscles;
         - steindler flexorplasty :
    - w/ C6 level paralysis brachioradialis & the ECRB / ECRL are only muscles functioning at the forearm and wrist;
         - consider transfer of ECRL to FDP  & BR  to FPL ;
         - consider transfer of biceps  to olecranon process inorder to assist extension of the elbow;
    - splints for C6 level;
         - pts require a wrist driven flexor hinge hand splint for prehension;
         - splints for C-6 escape:
               - proximal stability present;
               - loss of grasp
               - good candidate for flexor hinge hand splint;
    - ref: The Influence of Elbow Position on the Range of Motion of the Wrist Following Transfer of the Brachioradialis to the Extensor Carpi Radialis Brevis Tendon.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, December 8, 2011 12:48 pm