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CHAPTER 23
Biceps and radius reflexes are present, the triceps reflex may still be of paradox type.
The finger flexion reflex is exaggerated once the isolated cord develops its automatic
reflex function.
The sensory loss involves, apart from the body, the inner side of the arms and fore
arms as well as the ulnar side of the hands including the 5th~3rd fingers, sometimes
also to some degree the index finger.
C8 SEGMENT
There is no longer that abnormal posture of the upper limbs as described in C6 and Cy
lesions, for the adductors and internal rotators of the arms are strong enough to counter
act the overaction of their antagonists. The same applies to the triceps which can now
definitely extend the forearm against gravity and in due course regains full power. The
latissimus dorsi in co-operation with trapezius becomes strong enough to ensure the
upright position of the tetraplegic. The pronator teres can equalize the overaction of the
supinators of the hand, and the action of extensor carpi radialis brevis prevents the radial
deviation of the hand, caused by the extensor carpi radialis longus, the more so as the
extensor carpi ulnaris and flexor carpi ulnaris are also functioning; the long finger
flexors are now stronger. Moreover, the flexor pollicis longus and brevis, extensor
pollicis longus and abductor pollicis longus muscles are also working. The extensor
pollicis brevis, interossei and opponens are still greatly reduced in power or paralysed,
and abductor pollicis brevis is still completely paralysed as this muscle is mono-segmen-
tally innervated by Ti. The paralysis of the interossei and lumbricals results in a claw-
hand due to overaction of the extensor digitorum communis and flexor digitorum
sublimis and profundus. This, however, does not prevent the tetraplegic at that level
from writing, feeding himself, typing and taking up sport such as table tennis and
archery (see chapters on Physiotherapy and Sport).
Bilateral or unilateral Homer's syndrome and disturbances of sweating involving face,
arms and upper part of the trunk are present. The triceps reflex is either still absent or
diminished and so is the finger flexion reflex. The sensory loss includes the 5th and 4th
finger and hypothenar eminence and medial side of arm and forearm.
The respiratory distress is, as a rule, less pronounced. However, the loss of vasomotor
control is still apparent when the patient is raised from the horizontal to the upright
position but this can be overcome by training (see chapter on Physiotherapy).
In the past, life expectancy of tetraplegics involving even the distal cervical segments
was considered as very short—as a rule, no longer than a few months. Advances made in
the initial treatment of these patients has changed this dramatically (Guttmann, 1964).
Therefore, the problem of tetraplegia has become a social problem of increasing import
ance from year to year.
TI SEGMENT
Flexor digitorum profundus and sublimis, flexor policis longus and brevis, extensor
pollicis longus and brevis, abductor pollicus longus and opponens are functioning and
