eMedicine Specialties > Sports Medicine > Neurological

Brachial Plexus Injury: Differential Diagnoses & Workup

Author: Thomas H Trojian, MD, Assistant Professor of Family Medicine, Fellowship Coordinator, Sports Medicine Fellowship Director, Department of Family Medicine, University of Connecticut School of Medicine; Team Physician, University of Connecticut, Department of Athletics
Coauthor(s): Federico E Vaca, MD, FACEP, Team Physician, Department of Emergency Medicine, University of California Irvine; Clinical Assistant Professor, University of California at Irvine School of Medicine; Oniel Young, BS, College of Osteopathic Medicine of the Pacific
Contributor Information and Disclosures

Updated: Sep 5, 2006

Differential Diagnoses

Acromioclavicular Joint Injury
Cervical Spine Sprain/Strain Injuries
Cervical Disc Injuries
Shoulder Dislocation
Cervical Discogenic Pain Syndrome
Shoulder Impingement Syndrome
Cervical Radiculopathy
Thoracic Outlet Syndrome

Other Problems to Be Considered

Spinal cord injury
Cervical spine acute bony injuries
Cervical spine chronic bony injuries

Workup

Laboratory Studies

  • Lab studies generally are not indicated for the diagnosis of brachial plexus injuries.

Imaging Studies

  • Ancillary tests are often limited to radiographic studies.

    • Radiography can be used to rule out bony involvement against peripheral nerves. This is common in patients with severe neck pain, limited ROM, weakness, or chronic pain. Complete cervical spine radiographs often include the following multiple views: anteroposterior (AP), lateral, odontoid view, bilateral, and obliques.
    • Initial radiographs may reveal clues to spinal canal stenosis as a cause of the symptoms experienced. MRI of the spine may likely elucidate any evidence of canal stenosis.
       
  • Magnetic resonance imaging (MRI) is used to determine any involvement of the cervical spine or nerve roots as the cause of the brachial plexus injury. MRIs should be reserved for athletes with recurrent stingers or symptoms that last more than a week. Clinical judgment is needed as some cases warrant MRI if symptoms persist for more than 24 hours.

Other Tests

  • The electromyographic (EMG) studies are rarely necessary in the evaluation of stingers. The delay in development of abnormal activity limits their use to patients who have symptoms that last at least 2 weeks. EMG testing can help the physician confirm diagnosis and localize any possible lesions.

More on Brachial Plexus Injury

Overview: Brachial Plexus Injury
Differential Diagnoses & Workup: Brachial Plexus Injury
Treatment & Medication: Brachial Plexus Injury
Follow-up: Brachial Plexus Injury
References
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References

  1. Clancy WG Jr, Brand RL, Bergfield JA. Upper trunk brachial plexus injuries in contact sports. Am J Sports Med. Sep-Oct 1977;5(5):209-16. [Medline].

  2. Cramer CR. A Reconditioning Program to Lower the Recurrence Rate of Brachial Plexus Neurapraxia in Collegiate Football Players. J Athl Train. 10 1999;34(4):390-396. [Medline].

  3. Kuhlman GS, McKeag DB. The "burner": a common nerve injury in contact sports. Am Fam Physician. Nov 1 1999;60(7):2035-40, 2042. [Medline].

  4. Levitz CL, Reilly PJ, Torg JS. The pathomechanics of chronic, recurrent cervical nerve root neurapraxia. The chronic burner syndrome. Am J Sports Med. Jan-Feb 1997;25(1):73-6. [Medline].

  5. Markey KL, Di Benedetto M, Curl WW. Upper trunk brachial plexopathy. The stinger syndrome. Am J Sports Med. Sep-Oct 1993;21(5):650-5. [Medline].

  6. Sallis RE, Jones K, Knopp W. Burners. Offensive strategy for an underreported injury. Phys Sports Med. 20(11):47-55.

  7. Stracciolini A. Cervical burners in the athlete. Pediatr Case Rev. Oct 2003;3(4):181-8. [Medline].

  8. Weinberg J, Rokito S, Silber JS. Etiology, treatment, and prevention of athletic "stingers". Clin Sports Med. Jul 2003;22(3):493-500, viii. [Medline].

  9. Weinstein SM. Assessment and rehabilitation of the athlete with a "stinger". A model for the management of noncatastrophic athletic cervical spine injury. Clin Sports Med. Jan 1998;17(1):127-35. [Medline].

  10. Williams J, Hoeper E. Brachial plexus injury in a male football player. Curr Sports Med Rep. Jun 2004;3(3):125-7. [Medline].

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Further Reading

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Keywords

brachial plexus injury, stinger, burner, cervical nerve pinch syndrome, chronic burner syndrome, peripheral nerve injury

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Contributor Information and Disclosures

Author

Thomas H Trojian, MD, Assistant Professor of Family Medicine, Fellowship Coordinator, Sports Medicine Fellowship Director, Department of Family Medicine, University of Connecticut School of Medicine; Team Physician, University of Connecticut, Department of 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, and Society of Teachers of Family Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Federico E Vaca, MD, FACEP, Team Physician, Department of Emergency Medicine, University of California Irvine; Clinical Assistant Professor, University of California at Irvine School of Medicine
Federico E Vaca, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Association for the Advancement of Automotive Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Oniel Young, BS, College of Osteopathic Medicine of the Pacific
Disclosure: Nothing to disclose.

Medical Editor

Janos P Ertl, MD, Clinical Assistant Professor, Department of Orthopedic Surgery, Chief of Orthopedic Trauma, University of California at Davis; Director of Amputee Clinic, Kaiser Hospital
Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Hungarian Medical Association of America, Orthopaedic Trauma Association, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marlene DeMaio, MD, Consulting Staff, Department of Orthopedic Surgery, Assistant Professor, Bone & Joint/Sports Medicine Institute, Naval Medical Center
Marlene DeMaio, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American College of Sports Medicine, American Orthopaedic Foot and Ankle Society, and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon Whitehurst, MD, Consulting Staff, Rockford Orthopedic Associates
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Section of Orthopedic Surgery and Rehabilitation Medicine, Associate Professor, Department of Surgery, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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