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Brachial Plexus Injury in Sports Medicine Clinical Presentation

  • Author: Thomas H Trojian, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Nov 26, 2014
 

History

Commonly, the athlete may complain or describe burning and/or sensation of numbness in the proximity of the neck, shoulder, or upper extremity. The following symptoms usually follow a blow to the head, trapezius, or shoulder:

  • "Dead arm"
  • Pain in neck
  • Burning sensation between neck and shoulder
  • Dysesthesias
  • Affected extremity may feel weak or heavy
  • Paresthesias

Symptoms can last anywhere from a few seconds to weeks, depending on the extent of injury. Numbness in both upper extremities should alert the physician to a possible cervical cord injury.

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Physical

The physician should keep a high index of suspicion for potential cervical fracture and/or cord injury in the face of an athlete with any degree of altered level of consciousness. In the alert and awake athlete, a full neurologic examination is warranted.

  • Assessment of immediate mental status
  • Cervical nerve root assessment (motor and sensory)
  • Tenderness over Erb point
  • Spurling test
    • This test is best performed once cervical spine and neurologic assessment has been completed and no risk of potential spine injury is present.
    • The test is performed by extending the cervical spine with the head rotated toward the affected shoulder while cautious, but firm, axial loading is administered.
    • The purpose of the Spurling test is to reproduce the symptoms of a brachial plexus injury by manipulation of the neck. A positive Spurling test successfully reproduces the patient's symptoms.
  • On-field management and assessment of the injury is determined at the time of injury and should include the following:
    • Specific symptoms
    • Durations of symptoms
    • Cervical ROM within pain threshold when no suspicion of cervical fracture is present
    • Assessment for motor deficits
    • Grip strength
    • Early mobilization of the affected region
    • Icing of the affected region with care not to ice the peripheral nerve
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Causes

Classically, burner syndrome occurs as a result of a blow to the side of the head, shoulder, and/or Erb point. Spinal stenosis can also increase your risk of developing a stinger.

Burners are typically classified as grade 1 or grade 2.

  • Grade 1 describes neurapraxia, which is interruption of nerve function associated with demyelination. Remyelination occurs within 3 weeks of the incident, and axonal integrity is preserved. Weakness in muscle strength may be initially present in the acute examination. This may quickly develop and resolve in minutes but can also have a delayed onset.
  • Grade 2 involves axonotmesis, which is axonal damage and Wallerian degeneration. Weakness in muscle strength is often present; persistent weakness or bilateral involvement should raise the suspicion of a higher-grade lesion and further diagnostic studies should be performed.
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Contributor Information and Disclosures
Author

Thomas H Trojian, MD Professor of Family Medicine, Sports Medicine Fellowship Director, Department of Family Medicine, Associate Chief, Division of Sports Medicine, Drexel University College of Medicine; Lead Team Physician, Drexel Athletics

Thomas H Trojian, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Melissa Mascaro, MD Fellow in Sports Medicine, University of Connecticut School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Federico E. Vaca, MD, FACEP, and Oniel Young, BS, to the development and writing of this article.

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