"When talking about injuries to the cervical spinal cord, the level of injury is critical. A patient who has a C4 injury or above, essentially has no function of their extremities at all. A C4 level patient who is complete, may be able to shrug the shoulders, but typically cannot abduct the shoulders out to the side, cannot flex the elbows, can not use the arms and hands in any functional way. A C5 patient typically has gained control of the shoulders and the biceps, making them able to reach their mouth and move their arms in a functional way such as to move the wheelchair, but their hands are left totally impaired, unable to grasp or release an object. A C6 level patient has the ability to dorsiflex their wrist. That is, to bring the risk posteriorly, which causes a passive grasp. Oftentimes a patient with a C6 level cervical spinal cord injury can use this wrist extension to create what's called a tinodesis grasp. That is, when they extend the wrist, they can use this to cause the fingers to close around an object, and they can pick that object up in this indirect method. A C7 injury may have retained the ability to use the triceps or extend their arm out in front of them. And they also have the ability to turn the palm up and turn the palm down. That is, pronation. Having these additional functions, usually a patient can use their hands in a very useful way, even though they still lack a finger flexion extension. By the time we get down to a C8 or a T1 injury to the spinal cord, we have relatively functional hands that are missing dexterity and fine control. For each of these level of injuries, there are reconstructive procedures to restore function to the arms and hands. So the exact location of the injury to the spinal cord within the cervical spine determines which muscles the patient will still have control of in a useful way."
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