Management of Upper Extremities in Tetraplegia

Current Concepts

Michael S. Bednar, MD; Julie C. Woodside, MD


J Am Acad Orthop Surg. 2018;26(16):e333-e341. 

In This Article

Cervical Spine Injury and Classification

Cervical spine injuries are classified using the American Spinal Injury Association impairment scale, which grades the degree of spinal cord injury from A to E and as complete or incomplete based on sensory or motor preservation below the level of injury and presence of sacral sparing.[6] Although the American Spinal Injury Association classification is widely used to evaluate patients with tetraplegia, the levels are too broad to make decisions about reconstructive procedures of the upper extremities. The International Classification for Surgery of the Hand in Tetraplegia (ICSHT) was developed to evaluate the upper extremity and formulate a treatment plan for patients with quadriplegia (Table 1).[7] The ICSHT determines the number of muscles below the elbow with at least grade 4 strength. When examining individual muscles, manual motor testing is graded zero to 5 based on the British Medical Research Scale.[8]