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C5 Spinal Cord Injury: What to Expect and How to Improve Mobility

c5 spinal cord injury patient living a happy and fulfilling life

A C5 spinal cord injury is the second most common level of injury, making up about 15% of all SCIs.

Damage to the C5 spinal cord often results in paralysis of both the upper and lower body, otherwise known as quadriplegia. By participating in rehabilitative therapies, individuals can learn to adjust, cope, and manage the outcomes of their spinal cord injury.

To help you understand what to expect after a C5 spinal cord injury, this article will go over affected functions, recovery outlook, and potential complications.

Incomplete vs. Complete C5 Spinal Cord Injury

Spinal cord injuries are often classified as complete or incomplete. It’s essential to understand the differences between the two because they have different functional implications and recovery outlooks.

Individuals with a complete C5 spinal cord injury will have no sensation or control over movements below their level of injury because no spared neural pathways exist. In other words, there are no pathways to connect messages between the brain and areas below the level of injury.

In contrast, an incomplete C5 spinal cord injury will not transect the entire spinal cord and spared neural pathways will exist. As a result, some C5 SCI patients may be able to move and feel areas innervated below their level of injury.

Spared neural pathways play an essential role in determining rehabilitative outcomes after a C5 SCI because they are capable of neuroplasticity. Neuroplasticity is the central nervous system’s ability to rewire itself so functions affected by damage can potentially be relearned. The less severe a spinal cord injury is, the more spared neural pathways exist, and the better the recovery outlook.

However, neuroplasticity doesn’t work on its own. Individuals must stimulate it by repetitively practicing weakened movements. This will help the spinal cord understand that there is a demand for that function and promote neurological rewiring and strengthening. 

Up next, we’ll discuss functions affected by C5 SCI.

Functions Affected at the C5 Level of Injury

Dermatomes for spinal cord injury

Every level of the spinal cord connects to, or innervates, a different area of skin for sensation and set of muscles for movement.

According to the International Standards for Neurological Classification, sensation at the C5 level of injury is affected at the outer area of the upper arms. Physicians will test for sensation at the side of the elbow crease.

The primary muscles affected at the C5 level are the biceps and brachialis. The main functions of these muscles are to flex and supinate the forearm. Therefore, to test if motor control exists, spinal cord injury patients will be asked to bend their elbows.

Typically, complete C5 SCI patients will not be able to bend their elbows while those with incomplete C5 SCI should be able to with some weakness.

The C5 nerves also innervate part of the diaphragm, which will be further discussed later in the article.

Fortunately, functions above the level of injury will not be affected. As a result, C5 spinal cord injury patients have normal head and neck movements are able to raise their shoulders. They should also have normal sensation around the head, neck, shoulders, upper back, and collarbones.

In the following section, we’ll discuss potential outcomes of C5 spinal cord injury.

What to Expect After a C5 Spinal Cord Injury

As you’ve just learned, functional outcomes can widely range depending on the severity of one’s C5 spinal cord injury.

Below, we’ll discuss 7 possible outcomes of C5 spinal cord injuries:

1. Increased Dependence

c5 spinal cord injury patients may require a caregiver to help them perform activities of daily living

Because spinal cord injury can affect functions innervated below the level of injury, many individuals with C5 injuries may not be able to use their hands or wrists. With such limited mobility, individuals will likely need assistance with everyday tasks.

A caregiver can help C5 SCI patients with activities of daily living like transferring, grooming, toileting, bathing, dressing, and eating.

With the right training, many C5 spinal cord injury patients can learn how to adapt and improve self-care. This study demonstrated that while complete C5 spinal cord injury patients required assistance with bathing, toileting, and transferring, they may be able to feed themselves when provided with a prepared meal, dress their upper bodies when given clothing, and propel a manual wheelchair.

2. Spinal Shock

After a C5 spinal cord injury, individuals may lose all reflex activity below their level of injury and experience flaccid muscle tone due to spinal shock. Luckily, it is only a temporary condition.

Immediately following a spinal cord injury, the body’s inflammatory response triggers an outbreak of biochemical reactions in an attempt to protect and stabilize the spinal cord. However, these processes are harsh and can result in cell deaths, swelling, and reduced blood flow.

Blood is rich in oxygen and nutrients that are essential for cellular activity. Excessive swelling in the spinal cord can decrease blood flow by up to 80%, resulting in loss of reflexes and muscle tone below the level of injury.

Fortunately, swelling will die down and functions can gradually start to return as blood flow is restored. Spinal shock can last anywhere between a few days to 3 months. Individuals may be pleasantly surprised to find that their spinal cord injury isn’t as bad as they initially thought.

3. Spasticity

c5 spinal cord injury patient experiencing spasticity in the leg

Spasticity describes involuntary muscle contractions that can cause stiffness, spasms, and excess strain on the musculoskeletal system. The muscles remain contracted because they’re not receiving signals from the brain to relax.

However, spasticity is not always a bad thing. A little bit of spasticity can prove beneficial following a spinal cord injury and help promote independence.

For example, spasticity can cause otherwise paralyzed areas of the body to move. Although these movements are involuntary, they can help maintain muscle mass, promote circulation, and stimulate the spinal cord. Likewise, spasticity in the legs and arms can help individuals get dressed and stand up.

Being able to feel or move anything below your level of injury means that neural pathways still exist and are generally a good sign of recovery.

4. Bladder and Bowel Dysfunction

Bladder and bowel dysfunction are extremely common in SCI patients because the nerve roots that innervate the bladder and bowel muscles are located at the bottom of the spinal cord.

C5 spinal cord injury patients will typically experience high tone in their bladder and bowel muscles, which can reduce capacity and increase pressure. Complications of bladder and bowel dysfunction include urinary retention, kidney damage, infection, and constipation.

5. Respiratory Complications

c5 sci patient using ventilator due to weak breathing

The C3-C5 peripheral nerves innervate the diaphragm, a muscle that is essential to breathe. Generally, C5 spinal cord injury patients will not need the assistance of a ventilator but can still experience weakness due to paralysis of the intercostal muscles. C5 SCI patients who are ventilator-dependent often wean off it by the time they leave the hospital.

Common respiratory complications experienced by C5 spinal cord injury patients include:

  • Respiratory failure
  • Pneumonia
  • Pulmonary embolism
  • Sleep apnea
  • Atelectasis

6. Autonomic Dysreflexia

Many C5 spinal cord injury patients experience autonomic dysreflexia, which is primarily characterized by a sudden spike in blood pressure when areas below the level of injury are stimulated.

The autonomic nervous system is responsible for regulating involuntary processes in your body like blood pressure, temperature, and digestion. As a result, individuals may also experience feelings of panic, sweating, or tightness in the chest.

Normally, the brain will send signals throughout the body to relax the blood vessels. However, after an SCI, brain signals may be unable to reach areas below one’s level of injury. Consequently, areas above the level of injury will often have reduced blood pressure while areas below have high blood pressure.

7. Changes in Body Composition

Limited mobility after C5 spinal cord injury can make it challenging for individuals to be physically active. The human body is extremely adaptive and when you don’t use your muscles and bones, they shrink to conserve energy.

Many spinal cord injury patients initially lose a substantial amount of weight due to loss of bone density and muscle mass. However, many will also gain weight because they continue to consume the same amount of food as they did when they were more physically active. As a result, C5 spinal cord injury patients can experience significant changes in body composition.

Up next, we’ll discuss how to manage complications of C5 spinal cord injuries and improve mobility.

C5 Spinal Cord Injury Rehabilitation

Every C5 spinal cord injury is different, so a personalized rehabilitation plan that addresses each individual’s unique needs is essential.

Management interventions for C5 spinal cord injuries include:

  • Rehabilitation therapy typically consists of physical and occupational therapy, which both work towards optimizing mobility. PT focuses on exercises while OT uses a more practical approach and use activities of daily living. With the right training, many C5 spinal cord injury patients can learn how to adapt and improve self-care.
  • Orthotics are wearable devices that promote correct musculoskeletal alignment and form after C5 SCI. They can also help prevent spastic muscles from further contracting by holding the limb in place.
  • Adaptive devices are intended to help spinal cord injury patients with restricted mobility perform everyday activities on their own.
  • Medications will vary depending on your complications and can help minimize pain, reduce muscle contractions, and improve mental health status.
  • Surgery is typically performed immediately after SCI to stabilize the spine and minimize damage. It can also be recommended in cases of severe SCI where individuals may not be able to move due to spasticity.
  • Catheterization is commonly utilized when individuals cannot control their bladder muscles. It will help avoid accidents and prevent complications like urinary retention and kidney damage.
  • Bowel programs can help individuals better schedule and keep track of their bowel movements.
  • Breathing and coughing exercises will help C5 spinal cord injury patients increase their lung capacity and prevent the buildup of secretions.
  • Diet modifications will help prevent excess weight gain, promote bowel and bladder movements, and fuel the body for ideal recovery.

C5 SCI patients should also practice being mindful of their surroundings. Due to impaired sensation, individuals may not be aware when something they are touching is too hot or sharp.

Likewise, regular skin inspections can help identify signs of pressure sores or other irritations early and prevent them from worsening.

Understanding C5 Spinal Cord Injury: Key Points

The C5 level of the spinal cord generally affects movement and sensation at the upper arm. However, depending on the severity of your SCI, you may be able to move and feel areas innervated below your level of injury.

Every C5 spinal cord injury is unique and factors like rehabilitation intensity, motivation, and the occurrence of secondary complications can significantly impact recovery outcomes.

Hopefully, this article helped you understand that there is hope for recovery after C5 spinal cord injury and that participation in rehabilitation programs is essential to learn how to adapt and maximize your mobility. Good luck!


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