THE EFFECT OF A FLEXION CONTRACTURE OF THE ELBOW ON THE ABILITY TO TRANSFER IN PATIENTS WHO HAVE QUADRIPLEGIA AT THE 6TH CERVICAL LEVEL

We studied six patients (twelve upper extremities) who had quadriplegi a at the sixth cervical level, Our purpose was to evaluate how the los s of terminal extension of the elbow adversely affected the ability of the patient to perform transfers with a sliding board and so-called d epression raises (lifting of the body with use of the extended upper e xtremities to reduce the pressure on the ischial tuberosities). Functi on of the triceps muscle was considered to be absent in eight upper ex tremities and present in four. A flexion contracture of the elbow was simulated with use of a specially fabricated, hinged elbow brace. Term inal extension was progressively limited, in 5-degree increments, unti l the patient was no longer able to perform the transfer or the depres sion raise. The mean flexion contracture at which the patient could no t perform the transfer or the depression raise was approximately 25 de grees when function of the triceps was absent and approximately 50 deg rees when function of the triceps was intact, The results of this stud y emphasize the importance of maintaining the full range of motion of the elbow in a patient who has high-level quadriplegia, In a patient w ho has quadriplegia at the sixth cervical level who otherwise would be independent with regard to transfer skills and mobility in bed, a fle xion contracture of the elbow of approximately 25 degrees or more can result in the loss of a functional level and render the patient as dep endent as one who has quadriplegia at the fifth cervical level.