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Transient Brachial Plexopathy / Stinger / Burner

- 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 (1965; Clancy, et al. (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

Lateral-flexion neck injuries in athletic competition

Upper trunk brachial plexus injuries in contact sports

Brachial plexus injuries.  

Upper trunk brachial plexopathy in football players

Upper Trunk brachial plexopathy: The stinger syndrome

Acute brachial neuropathy in athletes.  

Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/stingers, thoracic outlet syndrome.