SPINAL CORD FUNCTIONING AT C6

What Motor Function is Consistent with C6?

• The nerve root of C6 runs between vertebrae C5 and C6. 
• Motor function includes:
  • strong bicep muscles (strong elbow flexion)
  • weak wrist extension 
  • tenodesis (ability to passively flex fingers with wrist extension)
  • shoulder rotation, adduction and abduction 

What Sensory Function is Consistent with C6?

• C6 sensation:
  • includes thumb side of lower forearm
  • thumb (radial nerve)
  • first finger (median nerve)

Assessment of C6 Motor Function

Shoulder:

• assess ability to rotate shoulder
• assess ability to abduct arm at shoulder (away from body)
  • assess abduction against examiner resistance
• assess ability to adduct arm at shoulder (toward body)
  • assesss adduction against examiner resistance

• have patient flex or bend elbow 
• evaluate the ability to bend the elbow while examiner holds forearm to create resistance
• C6 provides strong bicep

• assess ability to extend wrist
• assess ability to extend wrist against resistance

Digits:

• observe digits during wrist extension; passive digit flexion occurs with C6 during wrist extension
• assess ability to move thumb

• Test one side, then test same spot on opposite side
• Always apply the same amount of pressure to each side
• Ask patient to compare sensation on side A to side B
• Conceal test from the patient and test light touch and then pain separately. Test bilaterally  along thumb size of forearm, thumb and first finger

Light touch:

use wisp of cotton or tissue

Sharp or temperture touch:

use safety pin or blunt end needle

pain is a better assessment than temperature for this pathway because patients need to be able to articulate that they can distinguish hot or cold; this is unreliable among intubated patients

• feeding and grooming 
• able to use assisted devices to grasp objects
• can roll over and maneuver in bed 
• may drive car with hand controls 
• may be able to transfer ventilation