Review Question - QID 3733

This patient presents with a 'burner' or 'stinger,' a transient unilateral neurapraxia that most commonly involves the biceps, deltoid and rotator cuff muscles.

Hypotheses for the mechanism of neurapraxia in stingers include nerve root compression in the neural foramen as a result of extension and compression, traction on the brachial plexus or a direct blow to the plexus. C5-C6 is the most commonly involved level, indicating root injury or upper trunk brachial plexus injury. Unilateral and transient symptoms are required for diagnosis. Bilateral 'stinger' symptoms of numbness, tingling, and weakness are consistent with cervical spinal cord neurapraxia. Return to play in contact sports is contraindicated with bilateral symptoms prior to MRI evaluation of the cervical spine.

Shannon et al. review burner syndrome in athletes. They emphasize that criteria for return to play are based on a complete and thorough neurologic and physical exam. Normal strength and sensation in both upper extremities as well as a normal cervical spine exam (including range of motion, compression, Spurling's, Adson's, and resistive head pressures) are required for return to play. Any positive findings mandate withdrawal of the player from competition.

Illustration A shows hypothesized areas of involvement by mechanism according to Shannon et al. A, Extension-ipsilateral compression. B, Flexion-contralateral flexion (traction) or direct trauma.

Incorrect answers:
Answer 2: Triceps C7
Answer 3: Wrist flexors C7
Answer 4: Finger flexors C8
Answer 5: Interossei C8-T1