Spinal Cord Injury (SCI): Upper Limb Care

For people with SCI who have some upper limb mobility (ability to use the shoulders, arms, or hands), there is a risk for overuse. This can lead to upper limb problems or injury. During your rehabilitation, your healthcare team helped you learn the best ways to care for your upper limbs and the rest of your body. Once at home, you need to practice what you learned to stay healthy and avoid injury.

Understanding upper limb problems

Upper limb problems tend to develop slowly as a result of repetitive actions. These include pushing a wheelchair, reaching for objects overhead, or lifting the body for transfers and pressure relief. Over time, these actions can strain the upper limbs. Muscles, bones, and joints can be injured. This can lead to pain, loss of function, and loss of movement. The hands, wrists, elbows, and shoulders can all be affected.

  • Hands. The hands (and fingers) are prone to injuries, such as blisters, cuts, and abrasions. These are often caused by rubbing, scraping, or pinching the hands against wheelchairs parts and other surfaces.

  • Wrists. Carpal tunnel syndrome is the most common problem that affects the wrists. It occurs when the median nerve that runs through the wrist becomes irritated. This can happen after repeated use of the wrists. Carpal tunnel syndrome can cause numbness, tingling, or shooting pain in the hands and wrists.

  • Elbows. Elbow problems often involve too much pressure on the ulnar nerve. This nerve is located in the elbow. Over time, constant use of the elbow can cause the nerve to become inflamed and pinched. This can lead to pain or numbness.

  • Shoulders. Impingement syndrome (pinching in the shoulder) and tears in the rotator cuff (group of muscles and tendons that support the shoulder) are the most common problems that affect the shoulder. They can cause pain, swelling, weakness, or loss of function and movement.

When to get treatment

Limb problems can restrict your function. And they may require long periods for treatment and healing. If you develop pain, swelling, or weakness in your upper limbs, be sure to let your doctor know right away. The earlier an injury is caught, the sooner treatment can begin.

Protecting and maintaining upper limb function

A physical therapist (PT) or occupational therapist (OT) can work with you to help treat and prevent upper limb problems. This may involve:

  • Performing daily stretches and range-of-motion and resistance exercises to strengthen muscles and improve limb flexibility

  • Improving body movements to conserve limb strength and energy

  • Learning better techniques for transfers and to reduce pressure on the skin and also offer upper limb joint protection

  • Adjusting equipment to improve posture and provide proper support for limbs

Note: If needed, a family member or caregiver can learn how to help you with your limb care needs. Talk to your doctor, PT, or OT for more information.

Resources

To learn more about SCI, visit these websites:

  • The National Spinal Cord Injury Foundation, www.spinalcord.org

  • Christopher and Dana Reeve Foundation, www.christopherreeve.org

  • Paralyzed Veterans of America, www.pva.org



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