- Differential Diagnosis:
-Transient Brachial Plexopathy (Stinger/Burner)
-Cervical Cord Neuropraxia (Transient Quadriparesis)
-Stable cervical sprain
-Muscular strain
-Nerve root-brachial plexus axonotmesis
-Intervertebral disk herniation
-Unstable/Stable cervical fractures
-Subluxations
-Quadriplegia
-Clavicle fracture
-AC separation
-Peripheral nerve injury
-Axillary
-Long thoracic
-Spinal accessory
-Scapula fracture
-Rotator cuff tear
- Overview:
-“Burners/Stingers”
-Named for temporary sensation that radiates from the shoulder to the hand
-One of most common injuries in Sports Medicine
-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
- Discussion:
- Most often involves
C5 and
C6 nerve roots, which make up the upper trunk of the Brachial Plexus
- upper trunk
brachial plexus injuries are common football tackling injuries,
which may be refered to as "stingers;";
-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;
Upper trunk brachial plexus injuries in contact sports.
Am J Sports Med 1977;5:209-216.
Clancy WB, Brand RL, Bergfeld JA:
Brachial plexus injuries.
Clin Sports Med 1990;9:311-329. Hershmann EB:
Recurrent anterior subluxation of the shoulder in athletics: A distinct entity, in Proceedings of the AAOS.
Blazina ME, Satzman JS: J Bone Joint Surg 1969;51A:1037-1038.
Upper Trunk Brachial Plexopathy in Football Players.
WC Roberston, PL Eichman, WG Clancy.
JAMA, Vol 241. 1979. p 1480-1482.
Upper Trunk brachial plexopathy: The stinger syndrome.
KL Markey et al.
Am J. Sports Med. Vol 21. 1993. p 650-655.
