SCI stuff
Motor Points
Dermatomes and Peripheral Nerve Distributions
Convert your thinking from
peripheral nerves to spinal
cord segments:
Case #3: Damage to C8 @ Exit
C6 Neurological Level
Key Muscles:
C5: Deltoid, Biceps
C6: ECRL, ECRB
C7: Triceps
C8-T1: FDP, intrinsics
N-G
F-P
x
x
x
T-0
x
MMT to determine neurological level:
• If you test a muscle innervated by C5&6 and it tests 3/5, this
"Fair" strength grade is telling you the muscle is not fully
innervated.
• If you test another muscle innervated by C6 only or C6&7
and it is 0/5, the picture becomes clearer that C5 is
connected, C6 and higher numbers (lower levels of the cord)
are not.
• Further MMT of muscles with C5, C6, C7 innervations
confirms the finding, as does sensory testing using the
dermatome map.
MMT to determine neurological level:
• Functioning C5 and non-functioning C6 were
responsible for the first muscle strength @3/5; non
functioning C6 and lower levels are responsible for 0/5
strength in muscles innervated by the lower spinal
cord segments.
• Everything innervated by segments C5 and above
(segments located anatomically higher in the cord)
should test 5/5.
C4 C5 C6 C7 C8,T1
Neurological level continued . . .
Look on your charts and see why you think the following muscles
comprise the “short list” of Key Muscles:
• short list:
Scapular elevation
GH flexion, abduction; elbow flexion, forearm supination
Wrist extension
elbow extension
Thumb IP flexion (FPL), thumb abd., lumb./interosseus function
Refer to your grids and test the instructor . . .
MMT of:
• Scapular elevation
• Shoulder flexion
• Shoulder abduction
• Elbow flexion & forearm
supination
• Elbow extension
• Wrist extension
Muscles & Levels:
• Traps, lev scap (C4)
• Ant. Delts, pec major (C5)
• Middle delts (C5)
• Biceps (C5)
• Triceps (C7)
• ECRL & B (C6)
Refer to your grids and test the instructor . . .
MMT of:
• Scapular elevation
• Shoulder flexion
• Shoulder abduction
• Elbow flexion & forearm
supination
• Elbow extension
• Wrist extension
Muscles & Levels:
• Traps, lev scap (C4)
• Ant. Delts, pec major (C5)
• Middle delts (C5)
• Biceps (C5)
• Triceps (C7)
• ECRL & B (C6)
Links for functioning w/o triceps (without
active elbow extension):
•Skip: Elbow extension – hand free in space
reaching
•Skip: “Active elbow extension” against
gravity
•Skip: MMT of triceps = “proof”
Tenodesis:
Requires:
• Active wrist extension (via C6 innervated ECRL & B)
• Full wrist extension and flexion range of motion
• Full MCP, PIP, DIP flexion (for grasp) and enough
extension for release
• Short FDP and FPL*
*Try model with and without shortening the FDP
Links for Tenodesis:
• Tenodesis grasp and SCI: A good
video: https://www.youtube.com/watch?v=0YrD
Rvm-saU.
Also see
• Skip: Grasp of telephone receiver_tenodesis
• Skip: ROM to maintain joint motion and
allow/facilitate FDP/FPL shortening (contracture)