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A
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226/653
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C
11%
74/653
D
5%
35/653
His symptoms were likely not isolated to any single area
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The player most likely experienced a stinger or transient neuropraxia of the brachial plexus. When paresthesias are present, they do not follow a distinct dermatomal pattern (Answer 5). In contrast, weakness is most often seen in a C5-6 distribution (deltoid/biceps).Stingers, also known as burners, describe brachial plexus injuries that are usually transient, most commonly involving the upper trunk, specifically the exiting C5 and C6 nerve roots. Several potential mechanisms have been described, including brachial plexus traction injury, direct compression of the brachial plexus at Erb’s point, and nerve root compression caused by cervical spine hyperextension. Symptoms range from mild paresthesias to complete arm monoplegia and can last for a few seconds to several weeks in severe injuries. Treatment is generally nonoperative, with a return to play guided by the duration of the symptoms. Distinguishing from other, more severe injuries is an essential aspect of side-line athlete management. Symptoms that warrant further evaluation include repeat incidents, bilateral involvement, and persistent neurological deficits. Vaccaro et al. reviewed the current literature on cervical spine injuries in athletes to better characterize treatment algorithms and return to play. They report a lack of consensus within the literature and significant influence from outside parties to allow a return to play. Ultimately, the authors conclude that an intentional approach must be taken with consideration of the mechanism of injury, symptoms, and, when appropriate, radiographic evaluation. Fryhofer and Smith summarize the most common injuries in the cervical and lumbar spine suffered during athletics, which include stinger/burners, strains, stenosis/cord neuropraxia, disc herniation, and fracture/instability and lumbar strain, disc degeneration, disc herniation, and fracture. They report return-to-play (RTP) guidelines and reasonable expectations following each injury. The authors recommend following a general clearance protocol, including resolution of symptoms without neurologic deficit, full pain-free range of motion, and pain-free sport-specific exercise. Incorrect answers:Answers 1-4: Stingers are typically unilateral and do not involve a specific dermatome.
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