C-Spine

Brachial Plexus Burner

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Brachial Plexus Burner, Brachial Plexus Stinger, Stinger, Burner

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