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Unilateral symptoms do not resolve within 15 minutes.
11%
358/3371
Symptoms follow a short period of loss of conciousness.
3%
103/3371
Player has had unilateral symptoms on two prior occasions.
7%
243/3371
Transient unilateral weakness in the deltoid and biceps is present.
88/3371
Symptoms and physical exam findings are found in both upper extremities.
76%
2567/3371
Select Answer to see Preferred Response
In football player with numbness and tingling in the arms, it is critical to differentiate between a transient brachial plexopathy (burner) and cervical neuropraxia. In the latter, symptoms are bilateral, and an MRI is indicated prior to return to play. Transient brachial plexopathy, or burners, are common in football players and are caused by traction or a compression injury of brachial plexus. Return to play is allowed once the symptoms have subsided and the player exhibits normal strength and motion of the neck and upper extremities. Cervical neuropraxia is characterized by bilateral symptoms of numbness, tingling, and weakness. Return to play in contact sports is contraindicated with bilateral symptoms prior to MRI evaluation of the cervical spine. Rihn et al review cervical injuries in American football. They report "the relatively common 'stinger' is a neuropraxia of a cervical nerve root(s) or brachial plexus and represents a reversible peripheral nerve injury. Less common and more serious an injury, cervical cord neuropraxia is the clinical manifestation of neuropraxia of the cervical spinal cord due to hyperextension, hyperflexion or axial loading. Characterized by temporary pain, paresthesias and/or motor weakness in more than one extremity, there is a rapid and complete resolution of symptoms and a normal physical examination within 10 minutes to 48 hours after the initial injury." Thomas et al provide a review article of of cervical injuries in football players. They report cervical spine injuries have been estimated to occur in 10% to 15% of football players, most commonly in linemen, defensive ends, and linebackers. Avoiding techniques that employ head-down "spear" tackling and wearing properly fitted equipment markedly reduce the risk of serious injury. Incorrect Answers: Answer 1: Unilateral symptoms that don't resolve within 15 minutes is not an indication for an MRI. Answer 2: If a patient experiences a short period of loss of consciousness, than a CT of the head is indicated, not an MRI of the cervical spine. Answer 3: Recurrent "burners" is an indication for cervical radiographs, not an MRI. Answer 4: Unilateral transient weakness of the deltoid and biceps is commonly seen with "burners", and is not an indication for an MRI.
3.7
(24)
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