eMedicine Specialties > Sports Medicine > Neurological

Brachial Plexus Injury: Follow-up

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

Follow-up

Return to Play

Clinical findings are key in determining an athlete's possibility of returning to play. Full recovery of affected muscles must be determined to prevent further injury and recurrence of burner syndrome. Athletes in contact sports involving the neck should be able to support their weight at the neck leaning at a 45° angle. If this is possible without symptoms, then return to play is highly probable.

Some athletes may have very mild residual asymmetry in strength as a result of the initial injury. Close attention should be paid to the degree of disparity in extremity strength as the athlete returns to participation. Serial EMGs may be of little utility in this setting, as EMG changes can persist for months to years. However, in the setting of an acute change in strength pattern, reassessment may be warranted.

Recurrent stingers warrant assessment of equipment, inclusion of a cowboy collar for football players, and the coach to assess tackling technique.

Complications

Chronic burner syndrome

Prevention

Use protective equipment (eg, neck rolls, air cushions) in football players. Proper technique in contact sports (eg, tackling) is necessary, and improper methods (eg, spearing) should be discouraged. Coaches and referees involved with heavy contact sports also should discourage unnecessary tackling and contact. Cervical and paracervical muscular strengthening and conditioning are recommended.

Prognosis

Prognosis is good, yet some possibility of chronic symptoms may remain.

Education

For excellent patient education resources, visit eMedicine's Back, Ribs, Neck, and Head Center and Sports Injury Center. Also, see eMedicine's patient education articles Shoulder and Neck Pain and Neck Strain.

Miscellaneous

Medicolegal Pitfalls

  • Lack of consideration for a cervical spine injury can be problematic. The initial assessment by the sideline personnel and physician should maintain a healthy degree of suspicion for underlying spine injury. Some specialists maintain that a burner is a diagnosis of exclusion. 
  • For persistent symptoms of a burner, a complete assessment, and sometimes a multidisciplinary evaluation, may need to take place to avoid premature return to play.
  • Overlooking brachial plexus injury can lead to further damage to peripheral nerves without proper management.
 


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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