Posttraumatic syringomyelia can be a subtle entity initially. Awareness of the early clinical manifestations is a necessary adjunct in preventing the disabling sequela. Four case reports are examined with emphasis on temporal progression of symptoms and the resultant functional loss. The salient clinical features and a description of their pathogenesis are summarized. The presenting symptoms and signs were upper extremity reflex loss, musculoskeletal-type pain, and arm numbness. The functional impairments which resulted included the following: increased assistance with wheelchair mobility, significantly reduced performance of ADL, and loss of walking skill in a previously independent ambulator. Each patient underwent myelography (insufficient alone) as well as contrast CT scanning. Each patient underwent shunting with only one patient benefiting significantly. Syrinx formation must be included in the differential diagnosis of neuromuscular complaints by the spinal cord injured (SCI) population and treated appropriately.