Quadriplegia

Overview

What is quadriplegia?

Quadriplegia is a pattern of paralysis — which is when you can’t deliberately control or move your muscles — that can affect a person from the neck down. Depending on how and why it happens, it can affect your ability to move parts of your body, as well as some of your body’s automatic processes that keep you alive.

Quadriplegia (also known as tetraplegia; see below for an explanation of these terms) is usually a symptom of other problems, but there are some instances where it’s a standalone condition. Overall, quadriplegia is the most common symptom of traumatic spinal cord injury, happening in about 60% of cases.

There are also two main ways, complete and incomplete, that quadriplegia can happen.

  • Incomplete quadriplegia. This means that the quadriplegia blocks some — but not all — signals from getting through. That means a person might still have some ability to move, feel sensations or control automatic body processes (such as bowel and bladder function). This happens with about one-third of traumatic spinal cord injuries.
  • Complete quadriplegia. This means whatever causes the quadriplegia blocks all signals from getting through. That means a person loses muscle control, the ability to feel sensations and their brain can’t manage any automatic processes that rely on brain signaling to work. This happens with about 20% of spinal cord injuries.

There are also two main ways that paralyzed muscles act in quadriplegia:

  • Flaccid quadriplegia: This means that muscles don’t work at all and remain flaccid or limp.
  • Spastic quadriplegia: This type of quadriplegia results in muscles that don’t work by themselves and contract uncontrollably.

Quadriplegia vs. tetraplegia

The words “quadriplegia” and “tetraplegia” mean the same thing: paralysis below the neck that affects all of a person’s limbs. The reason that there are two terms with the same meaning is because of differences in ancient languages.

There are three ancient root words from two different languages involved in these terms:

  • Quadri-: This root word is Latin and means “four.”
  • Tetra-: This root word is Greek and also means “four.”
  • -plegia: This root word means “paralysis” in Greek.

So, while both words mean the same thing, “quadriplegia” mixes Latin and Greek. Experts usually consider “tetraplegia” the correct term because it doesn’t mix parts of two different languages.

How does the location of a problem affect quadriplegia?

Your spine has several sections. The cervical spine (often shortened to C-spine) is the section in your neck. There are seven vertebrae (the word for one of these is “vertebra”), interlocking bone segments, which make up your C-spine. Your C-spine also includes eight spinal nerves, which run in-between vertebrae and lead to different areas of your body.

The effects of a problem with a spinal cord can vary widely depending on where exactly it happens. There are also varying definitions of “paralysis.” Some experts define it as a total loss of muscle control, while others include muscle weakness under the definition. Because of that, some definitions of quadriplegia include limited movement ability in your arms or hands.

Healthcare providers use a letter-number combination to talk about sections of the spine and related spinal nerves. For example, the fifth cervical spinal nerve is known as C5. Quadriplegia can happen when there’s a complete or incomplete spinal cord injury anywhere between C1 and C8. The higher the injury, the more dangerous the effects.

The effects, depending on location, are as follows:

  • C1 to C2: Complete paralysis of all four limbs and the muscles that control your breathing. These injuries are almost always deadly without immediate care, especially breathing support (ventilation). Injuries at this level can also cut off your brain’s connection to other parts of your autonomic nervous system, which manages automatic functions like sweating, blood pressure control, digestion, and the muscles in your bladder and bowels you deliberately relax so you can pee or poop.
  • C3 to C4: Same as above, but damage that’s closer to C4 may not block your brain’s control of breathing muscles. Some breathing problems are still possible, and coughing is severely affected, which increases the risk of developing pneumonia as a complication.
  • C4 to C8: Varying levels of paralysis in your arms and hands. The further down your spinal cord, the less widespread the effects of the paralysis.

Possible Causes

What are the most common causes of quadriplegia?

There are many possible causes of quadriplegia. The most common reason people have this symptom is trauma (injury) to their spinal cord. The most common causes of trauma include:

  • Motor vehicle crashes (especially without the use of seat belts or when the crash causes a person’s ejection from a vehicle).
  • Falls (especially those that involve older adults who have bone density-related issues like osteoporosis or osteopenia).
  • Violence-related injuries (gunshot wounds, stab wounds, blunt impact, etc.).
  • Sports-related injuries.

Other problems that can cause quadriplegia include, but aren’t limited to, the following:

  • Spine tumors, including cancers. This can involve cancer that develops on or around your spinal cord, or that starts elsewhere in your body and spreads to your spine.
  • Cysts or fluid-filled cavities within your spinal cord (syringomyelia).
  • Infections that attack or compress your spinal cord.
  • Lack of blood flow (ischemia) due to a blocked blood vessel or blood vessel rupture.
  • Congenital conditions (that you have when you’re born) where you have a problem with your spine or spinal cord structure, such as myelomeningocele or spina bifida.
  • Injuries that happen during birth or very early childhood, causing conditions like cerebral palsy.
  • Autoimmune or inflammatory conditions like Guillain-Barré syndrome, multiple sclerosis or transverse myelitis.

Care and Treatment

How is quadriplegia treated?

The treatments for quadriplegia can vary widely depending on the cause and where in your spine the problem happens. The potential to recover from quadriplegia can also vary.

With trauma, the first priority is to limit the damage as much as possible and prevent more from happening. That usually involves immobilizing a person using specialized backboards, collars or braces to keep their spinal cord stable and prevent anything from pressing into or damaging it.

Other ways to prevent damage to the spinal cord from injuries and trauma include:

  • Early surgery to relieve pressure around the spinal cord.
  • Early surgery to stabilize or fuse vertebrae together to keep them from damaging the spinal cord.

Because of these factors, a healthcare provider is the best person to explain the situation. They can offer you guidance and relevant information for your specific situation, including the possible treatments and the side effects or complications that can happen with those treatments.

What can I do at home to treat quadriplegia?

IMPORTANT: If you’re with someone who has an injury that could affect their spine, it’s very important that you call 911 (or your local emergency services number immediately) and avoid doing anything that could make the injury worse.

Quadriplegia is a symptom of a problem that happens with many conditions and problems that affect your brain or spinal cord. Many of these problems and conditions are dangerous or deadly. Because of that, you shouldn’t try to self-diagnose or self-treat quadriplegia.

Even small movements or shifts in vertebrae and tissue around your spinal cord can lead to permanent damage. Only trained medical professionals or first responders should attempt to move someone with a possible spinal cord injury. The ONLY exception to this guidance is if the injured person is at risk for immediate injury or death if you don’t move them (such as in the event of a motor vehicle crash where the person is in a vehicle that may catch fire).

How can quadriplegia be prevented?

The most common cause of quadriplegia (trauma) is often preventable. The best things you can do to prevent spinal injuries and trauma are:

  • Wear safety equipment. Safety restraints (like seat belts) should be used whenever recommended. Seat belts and other restraints can help avoid injuries that could lead to quadriplegia. People playing sports should always use recommended safety gear, too. Helmets and padding are essential, as are playing conscientiously and safely. That means avoiding tackling/hitting from behind in contact sports like football, hockey, etc.
  • Take precautions to avoid falls. Use safety equipment, especially safety harnesses, when working on a roof or another elevated environment. You should also take steps to avoid falls in the home, especially with stairs or in bathrooms. This can include installing handrails, using non-slip footwear and floor surfaces, keeping stairs clear of tripping hazards.
  • Be careful when using firearms. Gunshot wounds are one of the most common causes of spinal cord injuries that lead to paraplegia. You should ALWAYS treat firearms with extreme caution, no matter the circumstance. Act as if they’re loaded even if you’re absolutely certain they aren’t. You should also store firearms unloaded, secured with a trigger lock and out of reach of children. It's also wise to store ammunition separately under lock and key.
  • Avoid misusing prescription medications, recreational drugs and alcohol. These can affect your immune system’s ability to fight infection. They can also increase your risk of injury from falls, car crashes, etc.

When to Call the Doctor

When should quadriplegia be treated by a doctor or healthcare provider?

A healthcare provider should ALWAYS examine and treat quadriplegia.

Frequently Asked Questions

What is spastic quadriplegia?

Spastic quadriplegia is a form of paralysis that happens because the affected muscles aren’t receiving signals from your brain. Without those signals, muscles can sometimes move on their own. Because these muscle movements are uncontrollable, this is still a form of paralysis.

What is the life expectancy with quadriplegia?

The life expectancy for people with quadriplegia can vary widely depending on many factors. These factors include a person’s age, the location and severity of the injury, whether or not it affects their ability to breathe on their own and more.

Thanks to advances in modern medicine, treatment techniques, and assistive devices and therapies, people with quadriplegia can live for years or even decades. However, because life expectancy can vary widely, a healthcare provider is the best person to tell you what’s most likely to happen in your case.

Can people with quadriplegia move their hands?

People with incomplete quadriplegia can sometimes move or use their arms and hands. Whether or not they can do so depends on the level and severity of the injury. The higher up the spine an injury happens, the less likely that hand or arm use is possible. A healthcare provider can tell you more about what to expect in specific situations.

Can quadriplegia be cured?

In some cases — though these are usually rare — quadriplegia is temporary or even curable. This is most likely when the problem involves disruptions in how the spinal cord works that don’t permanently damage or affect your spinal cord’s structure. Examples of these include infections or benign tumors. In general, a healthcare provider is the best person to tell you if quadriplegia is curable, as they can consider all the factors involved before telling you what you can and should expect.

Transient quadriplegia

One of the most common forms of temporary quadriplegia is a type of spinal compression that occasionally happens in athletes, especially football players. This is “transient quadriplegia,” and athletes often call this a “stinger” or “burner.” Those names come from the intense stinging or burning, especially in one or both hands, that a person feels, along with an inability to move their limbs

The effects of transient quadriplegia usually go away in 10 to 15 minutes but can take up to two days. Athletes who experience this also need immediate medical attention from qualified personnel (such as certified athletic trainers) to make sure they don’t have an injury to their spine or spinal cord that could cause permanent damage and paralysis.

IMPORTANT: When transient quadriplegia affects more than one limb, it should be treated like a medical emergency, and trained personnel should immediately respond as if the affected person has a spinal injury. That means the injured person needs immobilization to prevent further injury, and they need to go to a hospital right away so a healthcare professional can assess if they have an injury and begin treatment if necessary.

A note from Cleveland Clinic

Quadriplegia can be a frightening or devastating symptom of an injury to your spinal cord or brain. Depending on how and why it happens, quadriplegia is often permanent. Modern treatments and medical advances can offer some hope of recovery, but these vary widely from case to case. For those who face long-term or permanent effects, many assistive technologies and devices are now available, which can help those individuals with quadriplegia adapt and live more comfortably

Last reviewed by a Cleveland Clinic medical professional on 08/10/2022.

References

  • Adigun OO, Reddy V, Varacallo M. Anatomy, Back, Spinal Cord. (https://www.ncbi.nlm.nih.gov/books/NBK537004/) [Updated 2021 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/10/2022.
  • Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439316/) Front Neurol. 2019 Mar 22;10:282. Accessed 8/10/2022.
  • Bennett J, M Das J, Emmady PD. Spinal Cord Injuries. (https://www.ncbi.nlm.nih.gov/books/NBK560721/) [Updated 2022 May 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/10/2022.
  • Concannon LG, Bhatti OM, Fry AL, Harrast MA. Emergency Assessment and Care of the Athlete. In: Mitra R, eds. Principles of Rehabilitation Medicine. McGraw Hill; 2019.
  • Developmental Diseases of the Nervous System. In: Ropper AH, Samuels MA, Klein JP, Prasad S, eds. Adams and Victor's Principles of Neurology, 11e. McGraw Hill; 2019.
  • Disorders of the Autonomic Nervous System, Respiration, and Swallowing. In: Ropper AH, Samuels MA, Klein JP, Prasad S, eds. Adams and Victor's Principles of Neurology, 11e. McGraw Hill; 2019.
  • Douglas VC, Aminoff MJ. Spinal Trauma. In: Papadakis MA, McPhee SJ, Rabow MW, McQuaid KR, eds. Current Medical Diagnosis & Treatment 2022. McGraw Hill; 2022.
  • Hammer E, Brooks M, Bartels CM. Musculoskeletal Disorders. In: Boulton ML, Wallace RB, eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine, 16e. McGraw Hill; 2022.
  • Khan YS, Lui F. Neuroanatomy, Spinal Cord. (https://www.ncbi.nlm.nih.gov/books/NBK559056/) [Updated 2021 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Accessed 8/10/2022.
  • National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance. Birmingham, AL: University of Alabama at Birmingham, 2021.
  • Oropello JM, Mistry N, Ullman JS. Spinal Injuries. In: Hall JB, Schmidt GA, Kress JP, eds. Principles of Critical Care, 4e. McGraw Hill; 2014.

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