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101: TETRA/QUADRIPLEGIA

Mollie Venglar, DSc, MSPT, NCS; Megan Samantha Rosga, DPT, MSPT, NCS

CONDITION/DISORDER SYNONYMS

  • Tetraplegia

  • Quadriplegia

ICD-9-CM-CODE1

  • 344.0 Quadriplegia unspecified

ICD-10-CM CODE2

  • G82.50 Quadriplegia unspecified

PREFERRED PRACTICE PATTERN

  • 5H: Impaired Motor Function, Peripheral Nerve Integrity, and Sensory Integrity Associated with Nonprogressive Disorders of the Spinal Cord

PATIENT PRESENTATION

A 20-year-old man was transferred to the in-patient rehabilitation unit one week after a shallow water accident in which he hit a sandbar while surfing. He sustained a fracture in the cervical region. He has intact perianal sensation and all sensations intact to C7. His cervical fracture was stabilized via anterior approach with an iliac crest bone graft and screws. He wears a sternal-occipital-mandibular immobilizer (SOMI), abdominal binder, and compression stockings. He presents to in-patient rehabilitation in a reclined wheelchair due to orthostatic hypotension and lack of trunk control. His injury is assessed as a C7 incomplete, ASIA B (American Spinal Injury Association). Past medical history is unremarkable except for childhood illnesses/injuries.

KEY FEATURES

Description

  • Loss of motor and/or sensory function due to damage in the cervical spinal cord

Essentials of Diagnosis

  • Diagnosis is made by level of injury, severity of injury, and use of the ASIA assessment.

  • Quadriplegia is complete loss of sensory and motor function due to damage in cervical spine.

  • Quadriparesis is the partial loss of sensory or motor function due to damage in the cervical spine.

  • Quadriplegia is most commonly the result of trauma but can also occur due to infarction, hemorrhage, spinal stenosis.

FIGURE 101-1

A 21-year-old quadriplegic woman who had a motor vehicle accident 4 weeks ago. (From Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 101-2

The ratio of the spinal canal to the vertebral body is the distance from the midpoint of the posterior aspect of the vertebral body to the nearest point on the corresponding spinolaminar line (A) divided by the anteroposterior width of the vertebral body (B). (Reproduced with permission from Torg JS, Pavlov H, Genuaria SE. Neuropraxia of the cervical spinal cord with transient quadriplegia. J Bone Joint Surg Am. 1986;68:1354.)

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FIGURE 101-3

Dermatomes for sensory examination. (From Tintinalli JE, Stapczynski J, Ma OJ, Cline D, Cydulka R, Meckler G. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Damage to the cervical spinal cord ...

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