Brachial Plexus Injury in Sports Medicine Medication
- Author: Thomas H Trojian, MD; Chief Editor: Sherwin SW Ho, MD more...
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Opiate-Narcotics
Class Summary
Analgesia is important to obtain in the setting of brachial plexus nerve injuries. This can be accomplished by use of anti-inflammatory and/or opiate-narcotic medications. Analgesia may facilitate further assessment of the athlete, as well as their willingness to participate in therapy sessions.
Hydrocodone and acetaminophen (Lortab, Norcet, Vicodin)
Drug combination indicated for moderate to severe pain.
Hydrocodone and ibuprofen (Vicoprofen)
Drug combination indicated for short-term (less than 10 d) relief of moderate to severe acute pain
Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)
Drug combination indicated for the relief of moderate to severe pain.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Class Summary
Have analgesic and antiinflammatory activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Ibuprofen (Motrin, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Ketoprofen (Oruvail, Orudis, Actron)
For relief of mild to moderate pain and inflammation. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution and closely observe patient for response.
Naproxen (Naprosyn, Naprelan, Anaprox)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Chao S, Pacella MJ, Torg JS. The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics. Sports Med. 2010;40(1):59-75. [Medline].
Terzis JK, Kokkalis ZT. Selective contralateral c7 transfer in posttraumatic brachial plexus injuries: a report of 56 cases. Plast Reconstr Surg. Mar 2009;123(3):927-38. [Medline].
Bengtson KA, Spinner RJ, Bishop AT, Kaufman KR, Coleman-Wood K, Kircher MF, et al. Measuring outcomes in adult brachial plexus reconstruction. Hand Clin. Nov 2008;24(4):401-15, vi. [Medline].
Colbert SH, Mackinnon SE. Nerve transfers for brachial plexus reconstruction. Hand Clin. Nov 2008;24(4):341-61, v. [Medline].
Amrami KK, Port JD. Imaging the brachial plexus. Hand Clin. Feb 2005;21(1):25-37. [Medline].
Sulaiman OA, Kim DD, Burkett C, Kline DG. Nerve transfer surgery for adult brachial plexus injury: a 10-year experience at Louisiana State University. Neurosurgery. Oct 2009;65(4 Suppl):55-62. [Medline].
Terzis JK, Barmpitsioti A. Wrist fusion in posttraumatic brachial plexus palsy. Plast Reconstr Surg. Dec 2009;124(6):2027-39. [Medline].
Terzis JK, Kostopoulos VK. Vascularized ulnar nerve graft: 151 reconstructions for posttraumatic brachial plexus palsy. Plast Reconstr Surg. Apr 2009;123(4):1276-91. [Medline].
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].
Sallis RE, Jones K, Knopp W. Burners. Offensive strategy for an underreported injury. Phys Sports Med. 20(11):47-55.
Meeuwisse WH, Hagel BE, Mohtadi NG, Butterwick DJ, Fick GH. The distribution of injuries in men's Canada West university football. A 5-year analysis. Am J Sports Med. Jul-Aug 2000;28(4):516-23. [Medline].
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.
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].
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].
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].
Stracciolini A. Cervical burners in the athlete. Pediatr Case Rev. Oct 2003;3(4):181-8.
Weinberg J, Rokito S, Silber JS. Etiology, treatment, and prevention of athletic "stingers". Clin Sports Med. Jul 2003;22(3):493-500, viii.
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].
Williams J, Hoeper E. Brachial plexus injury in a male football player. Curr Sports Med Rep. Jun 2004;3(3):125-7.

