Abstract
The care of the hand in cervical spinal cord injury should be a well-organised programme in order to provide maximum function to the patient who is already severely disabled. The methods used should include careful examination and evaluation, attention to posture of the hand, range of motion exercises, the use of a wide variety of external aids, and occasionally judicious use of surgical techniques.
The rationale for such a programme is that such care will lead to a normal hand if neurological recovery occurs or the hand will be functional with or without splints and aids if paralysis persists.
It must be realised that the paralysed hand in permanent spinal cord injury will never be normal and that the patient will wisely take advantage of the tenodesis effect of the finger flexors as the wrist extends. Because most cord injury patients develop this automatic type hand, efforts should be made from the time of injury so that the hand and wrist will be functional. Efforts should develop the kind of position, mobility of the wrist and palm, and tightness of finger flexors to permit good closure of the fingers on wrist extension to allow functional use for wheelchair existence.
Surgery to the hand is valuable for a small percentage of patients. In general it is unwise to perform reconstructive procedures until enough time has been allowed for nerve root injuries to recover which is about one year following injury.
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Freehafer, A. Care of the hand in cervical spinal cord injuries. Spinal Cord 7, 118–130 (1969). https://doi.org/10.1038/sc.1969.22
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DOI: https://doi.org/10.1038/sc.1969.22