1. SCI stuff

2. Motor Points

3. Dermatomes and Peripheral Nerve Distributions

4. Convert your thinking from peripheral nerves to spinal cord segments:

5. Case #3: Damage to C8 @ Exit

6. C6 Neurological Level N-G T-0 x x x x F-P Key Muscles: C5: Deltoid, Biceps C6: ECRL, ECRB C7: Triceps C8-T1: FDP, intrinsics

8. 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.

9. 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.

10. 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 C4 C5C6C7C8,T1

13. 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)

14. 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)

15. Links for functioning w/o triceps (without active elbow extension): Skip: Elbow extension – hand free in space reachingElbow extension Skip: “Active elbow extension” against gravityActive elbow extension Skip: MMT of triceps = “proof”MMT

16. 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

17. Links for Tenodesis: Tenodesis grasp and SCI: A good video: https://www.youtube.com/watch?v=0YrD Rvm-saU.https://www.youtube.com/watch?v=0YrD Rvm-saU Also see Skip: Grasp of telephone receiver_tenodesisGrasp Skip: ROM to maintain joint motion and allow/facilitate FDP/FPL shortening (contracture)ROM