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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.