Updated: 10/22/2016

Burners & Stingers

Topic
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Questions
6
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Evidence
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https://upload.orthobullets.com/topic/3115/images/Brachial Plexus with sensory 566_moved.jpg
Introduction
  • Also known as "dead arm syndrome" or brachial plexopathy
    • refers to transient brachial plexus neuropraxia
    • can be serious if they are recurrent or long lasting
  • Epidemiology
    • common in collision sports such as football 
    • having 1 stinger increases risk of another by 3X
  • Pathoanatomy
    • neurapraxias are caused by different mechanisms including
      • traction injury
        • occurs by downward displacement of arm and bending of neck away from side of injury 
      • compression injury
        • occurs by lateral head turning toward affected side
      • direct blow
        • can cause injury with blow at Erb's point superior to the clavicle
Anatomy
  • Brachial plexus 
    • with motor and sensory innervation  
Presentation
  • Symptoms
    • unilateral tingling in arm not typically isolated to a single dermatome 
    • usually resolve quickly in 1-2 minutes
  • Physical exam
    • full cervical ROM
    • no tenderness
    • unilateral transient weakness in C5, C6 muscles (deltoid, biceps) 
    • can have positive Spurling test 
Imaging
  • Radiographs
    • usually unremarkable
    • C-spine images indicated with recurring symptoms
      • to rule out fx and cervical stenosis
  • MRI
    • indicated whenever symptoms are bilateral (inconsistent with stinger) 
      • to rule out cervical spine pathology such as herniated disc or cervical stenosis
  • EMG
    • indicated if symptoms persist after 3 weeks
      • will show abnormalities in roots, cords, trunks, and peripheral nerves
Treatment
  • Nonoperative
    • return to play
      • a player may return to play when
        • complete resolution of symptoms
        • normal strength and range of motion 
      • contraindications to return to play include
        • recurring symptoms 
          • until cervical spine xrays are obtained
  • Prevention
    • try different neck collars for football players
 

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Questions (6)
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(SBQ07SM.36) In college level football players with symptoms of arm numbness and tingling following contact, which of the following is an indication for a cervical MRI prior to return to play? Review Topic

QID: 1421
1

Unilateral symptoms do not resolve within 15 minutes.

10%

(154/1512)

2

Symptoms follow a short period of loss of conciousness.

2%

(37/1512)

3

Player has had unilateral symptoms on two prior occasions.

7%

(102/1512)

4

Transient unilateral weakness in the deltoid and biceps is present.

2%

(29/1512)

5

Symptoms and physical exam findings are found in both upper extremities.

78%

(1184/1512)

ML 2

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ04.99) A football player is diagnosed as having a "stinger" by the athletic trainer. Which of the following acute transient findings would be consistent with that diagnosis? Review Topic

QID: 1204
1

Bilateral upper extremity sensory symptoms

5%

(78/1463)

2

Bilateral upper extremity weakness

1%

(13/1463)

3

Unilateral upper and lower extremity sensory and motor symptoms

3%

(51/1463)

4

Unilateral upper and lower extremity weakness only

1%

(8/1463)

5

Unilateral upper extremity pain and weakness

89%

(1303/1463)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 5

(OBQ10.9) An 18-year-old football player comes off the field after sustaining a stinger to his right shoulder. Which of the following conditions must be met before he should be allowed to return to play? Review Topic

QID: 3097
1

Determine if the pain has resolved and fit the player with a protective brace

0%

(6/1922)

2

MRI of the right shoulder and neck showing no nerve root avulsions

1%

(11/1922)

3

No pain, normal sensation, demonstration of full range of motion, and 5/5 strength of the right upper extremity musculature

96%

(1839/1922)

4

Normal sensation in the right hand over the thumb, long finger, and small finger, no residual pain, and the ability to raise the right hand above his head

3%

(51/1922)

5

Normal findings on an EMG of the right shoulder and arm

0%

(4/1922)

ML 1

Select Answer to see Preferred Response

PREFERRED RESPONSE 3
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