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;