C-Spine
Brachial Plexus Burner
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Brachial Plexus Burner
, Brachial Plexus Stinger, Stinger, Burner
See Also
Peripheral Nerve Injury
(
Neuropraxia
)
Cervical Spine Injury
Epidemiology
Occurs in
Contact Sport
s (esp. football, wrestling)
Most common c-spine related injury in football
Incidence
as high as 65% per football player (and 50% of other collision athletes)
Mechanism
Neuropraxia
of nerve roots or
Brachial Plexus
Cervical nerves pinched by extension-compression
Brachial Plexus
stretched during block or tackle
Most commonly affected at C5 and C6
Older athletes
Disc disease or other pathology in 94% of cases
Symptoms
Sharp, burning pain in
Shoulder
with
Paresthesia
Typically unilateral
Symptoms last seconds to minutes
Radiation into arm and hand
Follows circumferential pattern of
Paresthesia
s
Does not follow dermatomal distribution
Motor weakness may occur at time of injury or develop hours to days later
Red flags
Consult Neurosurgery
Findings suggestive of serious
Cervical Spine Injury
Persistent symptoms (especially >24 hours)
Burners usually resolve in minutes
Bilateral symptoms
Upper and lower extremities involved
C-Spine range of motion diminished or spinal process tenderness
Evaluation
Serial examinations
Baseline
Repeat in 24 hours and then every few days for first 2 weeks
Diagnostics
Indications
New or significant worsening symptoms
Recurrent Stingers
Studies
Nerve Conduction Studies
and EMG
MRI C-Spine
Consider neurosurgery
Consultation
Management
Sideline
Indications to return to play after brief event
All symptoms resolve within 15 minutes
No concern for
Cervical Spine Injury
Return to play requires at least one repeat examination during event
Cantu (1997) Med Sci Sports Exerc 29(7 Suppl): S233-5 [PubMed]
Management
Gene
ral
No
Contact Sport
s until symptoms resolve
Evaluate for associated head and neck injury
See
Cervical Spine Injury
See
Concussion in Sports
Assess for
Brachial Plexus Injury
Symptom duration determines return to play
Symptoms that resolve in minutes may return to play
See return to play indications below
Symptoms persist in 5-10% of cases
Full evaluation needed if symptoms last >24 hours
Return to play indications
Symptoms resolved and
No pain with
Cervical Spine
range of motion and
Normal radial pulses and
Normal
Neurologic Exam
Normal strength exam
Normal
Sensory Exam
Recurrent symptom evaluation
Assess for
Cervical Spinal Stenosis
Course
Pain and
Paresthesia
resolves quickly, seconds-minutes
Weakness typically resolves within 24 hours, but may persist for days up to 6 weeks
Persistent weakness or sensory changes beyond 2 weeks
Suggests
Brachial Plexus Injury
Prevention
Isotonic Exercise
s for neck and
Shoulder
Preventive equipment
Neck roll
"Cowboy" collar
References
Kalsi, Kaufman and Hudson (2018) Crit Dec Emerg Med 32(10): 3-10
Page (2004) South Med J 97:766-9 [PubMed]
Nissen (1996) Physician Sportsmed 24:57-64 [PubMed]
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