Brachial Plexus Injuries

• Chapter 11• Athletic Injury

Assessment

Clinical Anatomyp.371

• Innervation for upper extremity

• Levels--fig.11-5, .371• C5-T1nerve roots

– Upper trunk:C5-C6– Middle trunk: C7– Lower trunk: C8-T1

Brachial Plexus Pathology

• “Burners” or “Stingers”

• Nerve stretch or compression

• FB: more common in defensive players

• Assess all dermatomes C5-T1 in assessment

• Table 11-6, p. 386

Brachial Plexus Pathology—p. 385

• Mechanisms:– acute onset– traction/stretch– compression– fig. 11-16, p. 385

• Symptoms:– burning/tingling in

upper extremity– weakness in UE

Brachial Plexus Pathology

• Other considerations:– cervical spine injury– cervical stenosis

• Rule out other injuries• No clearance until all

symptoms resolve completely

Brachial Plexus Pathologyp.387

• Assessment:– Brachial plexus

traction test--• p.387• Box 11-5, p. 387• 2 possible results

– Possibly (+) Spurling test

– Dermatome testing

Brachial Plexus Myotomes

• C5: shoulder abd./ER• C6: elbow flex.; wrist

ext• C7: elbow ext.; wrist

flex.• C8: finger flex.• T1: finger abd.

Brachial Plexus Injury: Treatment

• Remove from contact• Test/Retest• Rule out other

pathologies– Bilateral weakness– Weakness outside

brachial plexus (shoulder shrug)

Brachial Plexus Injury: Return to Play Guidelines

• Full painfree AROM in UE and neck

• Normal sensation• Correction of

technique/ equipment to prevent re-injury

Cervical Stenosis

• Signs/Symptoms:– recurrent stingers– bilateral complaints– proper technique– neurological signs

outside of brachial plexus

– transient quadriplegia– usually congenital

problem

Cervical Stenosis

– Cervical spinal canal usu. 14.5mm-20mm(C3-C6)

– CSF coats and cushions spinal cord

– small canal or large cord may = stenosis

– Medical imaging used to measure risk

Cervical Stenosis: Assessment

– Torg Ratios• VB=SC (+/-

20%)=NL• C4-C6

• original research did not include FB players

– 1990--33% of NFL had stenosis

• stenosis=ratio BUT • ratiostenosis

– Imaging• x-ray (magnification)• CT Scan/MRI• Contrast CT• C-spine vs whole

spine

Cervical Stenosis: Management– Symptoms dictate

workup– Imaging:

• x-rays to determine Torg ratio

• If Torg ration outside of NL ranges (.8-1.2) then CT/MRI

• whole spine imaging?

Cervical Stenosis: Management

– Return to Play• Assess risks based on

imaging/ratios• Assess possible

technique changes• if stenotic-avoid all

sports which threaten the C-spine

Burners vs. Stenosis

• Burners• One-sided• Acute• Strong cause-effect• Limited to brachial

plexus only• Normal imaging• Normal Torg ratio

• Stenosis• Bilateral• Chronic• Poor cause-effect• Extends beyond

brachial plexus• Abnormal imaging• Abnormal Torg ratio