- 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.
Upper trunk brachial plexopathy in football players.
Upper Trunk brachial plexopathy: The stinger syndrome.