Tetraplegia

Paralysis affecting all four limbs and torso

Tetraplegia (Quadriplegia)
Synonyms	Quadriplegia
Pronounce
Field	Neurology, Physical Medicine and Rehabilitation
Symptoms	Paralysis of arms, legs, and torso; loss of sensation; difficulty with bowel, bladder, and respiratory functions
Complications	Pressure ulcers, infections, respiratory issues, autonomic dysreflexia
Onset	Sudden (trauma) or gradual (neurological conditions)
Duration	Chronic
Types	N/A
Causes	Spinal cord injury, stroke, multiple sclerosis, cerebral palsy, ALS
Risks	High-risk physical activities, degenerative neurological diseases
Diagnosis	Physical examination, MRI, CT scan, nerve conduction studies
Differential diagnosis	Paraplegia, transverse myelitis, spinal cord tumor
Prevention	Safety measures for spinal injury, early treatment of neurological conditions
Treatment	Physiotherapy, occupational therapy, assistive devices, medications, surgery
Medication	Muscle relaxants, pain relievers, blood pressure management
Prognosis	Variable, depending on severity and rehabilitation efforts
Frequency	Rare (varies by region and cause)
Deaths	Can be life-threatening if complications arise

Tetraplegia, also known as quadriplegia, is a neurological condition characterized by partial or complete loss of motor and sensory function in all four limbs and the torso. It commonly results from spinal cord injuries (SCI) at or above the cervical (C1–C8) level, but can also be caused by neurological diseases affecting the central nervous system.

Causes

The most common causes of tetraplegia include:

• Traumatic spinal cord injury (SCI) – The leading cause, typically from:
• Motor vehicle accidents
• Falls
• Sports injuries
• Acts of violence (e.g., gunshot wounds)
• Neurological disorders:
• Stroke – Damage to brain regions controlling movement
• Multiple sclerosis (MS) – Autoimmune damage to nerve insulation (myelin)
• Cerebral palsy – Congenital disorder affecting muscle control
• Amyotrophic lateral sclerosis (ALS) – Progressive neurodegenerative disease
• Transverse myelitis – Inflammatory attack on the spinal cord
• Guillain-Barré syndrome – Immune-related nerve dysfunction
• Tumors or infections affecting the spinal cord or brainstem

Pathophysiology

Tetraplegia occurs when nerve pathways responsible for movement and sensation are disrupted at the cervical spinal cord level. The extent of paralysis depends on the level and severity of the damage:

• Complete SCI (ASIA A classification) – Total loss of movement and sensation below the injury site.
• Incomplete SCI (ASIA B-D classification) – Some preserved movement or sensation.

The spinal cord damage results in:

• Loss of voluntary muscle control below the injury.
• Impairment of autonomic functions, leading to blood pressure instability, bowel and bladder dysfunction, and thermoregulation issues.
• Neurogenic shock in acute injuries, affecting blood circulation and breathing.

Clinical Presentation

Individuals with tetraplegia exhibit varying degrees of paralysis and loss of sensation, depending on the level of spinal cord injury:

Motor and Sensory Deficits

• C1-C3 injuries – Complete paralysis, ventilator dependence due to loss of diaphragm control.
• C4 injuries – Partial diaphragm control but limited arm movement.
• C5 injuries – Shoulder and elbow movement present, but weak grasp.
• C6 injuries – Wrist extension possible, but hand function remains limited.
• C7-C8 injuries – Improved hand function but still limited dexterity.

Associated Complications

Individuals with tetraplegia often experience:

• Respiratory problems – Increased risk of pneumonia, weak coughing, and ventilator dependency in higher cervical injuries.
• Autonomic dysreflexia – A dangerous rise in blood pressure triggered by stimuli below the injury level.
• Pressure ulcers – Due to prolonged immobility and lack of sensation.
• Bladder and bowel dysfunction – Loss of voluntary control, requiring catheterization or bowel programs.
• Spasticity and contractures – Uncontrolled muscle tightness leading to joint deformities.

Diagnosis

Diagnosis of tetraplegia involves:

• Clinical examination – Assessing muscle strength, reflexes, and sensation.
• Imaging studies:
• MRI – Detects spinal cord compression, herniated discs, or tumors.
• CT scan – Identifies fractures and bony abnormalities.
• Electrodiagnostic tests:
• Nerve conduction studies (NCS)
• Electromyography (EMG)
• Functional independence assessments – Evaluating ability for self-care and mobility.

Treatment

Currently, there is no cure for tetraplegia, but treatment aims to maximize function, improve quality of life, and prevent complications.

Rehabilitation Approaches

• Physiotherapy – Helps maintain muscle mass, prevent contractures, and improve circulation.
• Occupational therapy – Focuses on assistive devices and functional independence.
• Speech and respiratory therapy – Especially for higher cervical injuries.
• Assistive technology – Power wheelchairs, voice-controlled devices, and robotic exoskeletons.

Medical Management

• Muscle relaxants (e.g., baclofen, tizanidine) – Reduce spasticity.
• Pain management (NSAIDs, opioids, gabapentinoids) – Controls neuropathic pain.
• Bladder control medications (anticholinergics) – Help with urinary incontinence.
• Blood pressure stabilizers – Prevent complications from autonomic dysreflexia.

Surgical Interventions

• Spinal stabilization – Fusion or decompression surgery for traumatic injuries.
• Nerve transfers – Restoring function by rerouting intact nerves.
• Diaphragm pacing – Assisting breathing in high cervical injuries.

Prognosis

The prognosis for individuals with tetraplegia varies depending on injury severity, rehabilitation efforts, and access to healthcare.

Prognostic Factors

• Complete SCI – Lower likelihood of regaining function.
• Incomplete SCI – Greater potential for motor recovery.
• Early rehabilitation – Leads to better functional outcomes.
• Higher-level injuries (C1-C4) – Associated with greater dependency on caregivers and assistive devices.

Prevention

Preventing tetraplegia primarily involves:

• Motor vehicle safety – Seat belts and airbags reduce spinal injuries.
• Sports safety – Helmets and proper training lower the risk.
• Fall prevention – Especially in older adults and those with osteoporosis.
• Early diagnosis of neurological conditions – Managing MS or ALS can slow progression.

See Also

• Paraplegia
• Spinal cord injury
• Neurological disorders
• Physical therapy
• Occupational therapy

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