- Discussion:
- upper trunk
brachial plexus
injuries are common football tackling injuries, which may be refered to as
"stingers;";
- named for temporary sensation that radiates from the shoulder to the
hand;
- most often involves
C5
and
C6 nerve roots, which make up the upper trunk of the brachial plexus
- occurence of 65% of collegiate football players during 4-year career
- often go unreported - most episodes last seconds to minutes
- 5-10% of cases, neurologic deficit may last hours, days, or weeks
- mechanism:
- brachial plexus stretch / traction
- direct blow causing contralateral lateral neck flexion and
ipsilateral shoulder depression or traction as
nerve is fixed proximally
- more frequent in younger athletes w/o cervical stenosis or
degenerative changes
- similar to Erb’s palsy seen in birth injury, (Chrisman JAMA 1965)
(Clancy et al. AJSM 1977)
- Clinical Findings:
- burning pain radiating from the affected shoulder circumferentially down
the arm;
- they have been noted to occur in more than 50% of players;
- its important to note that no complaints of neck pain occur w/ "stingers"
- player should not return to competition if he neck pain or has
motor weakness;
- Exam Findings:
- weakness of shoulder abductors and external rotators as well as
biceps weakness;
- Radiographs:
- look for cervical rib and/or cervical spine transverse process avulsion
fracture;
- fracture of the clavicle or scapula
- EMG:
- helps determine location (
preganglionic
or postganglionic) and severity of nerve root injury;
- Differential Diagnosis:
- cervical cord neuropraxia (transient quadriparesis)
- stable cervical sprain
- nerve root - brachial plexus axonotmesis
- intervertebral disk herniation
- unstable / stable cervical fractures
- clavicle fracture
- AC separation
- peripheral nerve injury
- scapula fracture
- rotator cuff tear