A 20-year-old man sustains a C6 complete spinal cord injury (AIS grade A) in a diving accident. Based on the C6 level, which functional ability and the appropriate assistive device or surgical intervention is most relevant?

• A Wrist extensors (ECRL/ECRB) are preserved; patient can use wrist-driven tenodesis for grip and drive a powered wheelchair with hand controls; tendon transfer may restore hand function ✓
• B Complete tetraplegia with no upper limb function; will require full-time ventilator support
• C Full hand grip and pinch are preserved; patient can write and self-catheterise independently
• D Elbow extensors (triceps) are preserved, enabling independent manual wheelchair propulsion

Explanation

C6 level SCI preserves radial wrist extensors (ECRL/ECRB, C6 innervation) but lacks hand intrinsics and long finger flexors/extensors. Key functional implications: the patient can use wrist extension to passively close the fingers through tenodesis effect (flexor tendons tighten as wrist extends), enabling a tenodesis grip for light objects. They can drive using hand controls. Active tendon transfer surgery (e.g., brachioradialis to flexor pollicis longus for thumb pinch) can restore functional grip. A C5 injury has no wrist extension; ventilator dependence occurs at C3 and above. Triceps (C7) enables manual wheelchair propulsion in C7 injury. C6 injury requires powered or heavily assisted manual chair.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.