Brachial Plexus Injury in Sports Medicine Clinical Presentation

Updated: Jun 19, 2017
  • Author: Thomas H Trojian, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Presentation

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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