Transcript SCI stuff
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)