II. Epidemiology
- Occurs in Contact Sports (esp. football, wrestling)
- Most common c-spine related injury in football
- Incidence as high as 65% per football player (and 50% of other collision athletes)
III. Mechanism
-
Neuropraxia of nerve roots or Brachial Plexus
- Cervical nerves pinched by extension-compression
- Brachial Plexus stretched during block or tackle
- Most commonly affected at C5 and C6
- Older athletes
- Disc disease or other pathology in 94% of cases
IV. Symptoms
- Sharp, burning pain in Shoulder with Paresthesia
- Typically unilateral
- Symptoms last seconds to minutes
- Radiation into arm and hand
- Follows circumferential pattern of Paresthesias
- Does not follow dermatomal distribution
- Motor weakness may occur at time of injury or develop hours to days later
V. Red flags
- Consult Neurosurgery
- Findings suggestive of serious Cervical Spine Injury
- Persistent symptoms (especially >24 hours)
- Burners usually resolve in minutes
- Bilateral symptoms
- Upper and lower extremities involved
- C-Spine range of motion diminished or spinal process tenderness
- Persistent symptoms (especially >24 hours)
VI. Evaluation: Serial examinations
- Baseline
- Repeat in 24 hours and then every few days for first 2 weeks
VII. Diagnostics
- Indications
- New or significant worsening symptoms
- Recurrent Stingers
- Studies
- Nerve Conduction Studies and EMG
- MRI C-Spine
- Consider neurosurgery Consultation
VIII. Management: Sideline
- Indications to return to play after brief event
- All symptoms resolve within 15 minutes
- No concern for Cervical Spine Injury
- Return to play requires at least one repeat examination during event
- Cantu (1997) Med Sci Sports Exerc 29(7 Suppl): S233-5 [PubMed]
IX. Management: General
- No Contact Sports until symptoms resolve
- Evaluate for associated head and neck injury
- See Cervical Spine Injury
- See Concussion in Sports
- Assess for Brachial Plexus Injury
- Symptom duration determines return to play
- Symptoms that resolve in minutes may return to play
- See return to play indications below
- Symptoms persist in 5-10% of cases
- Full evaluation needed if symptoms last >24 hours
- Symptoms that resolve in minutes may return to play
- Return to play indications
- Symptoms resolved and
- No pain with Cervical Spine range of motion and
- Normal radial pulses and
- Normal Neurologic Exam
- Normal strength exam
- Normal Sensory Exam
- Recurrent symptom evaluation
- Assess for Cervical Spinal Stenosis
X. Course
- Pain and Paresthesia resolves quickly, seconds-minutes
- Weakness typically resolves within 24 hours, but may persist for days up to 6 weeks
- Persistent weakness or sensory changes beyond 2 weeks
- Suggests Brachial Plexus Injury
XI. Prevention
- Isotonic Exercises for neck and Shoulder
- Preventive equipment
- Neck roll
- "Cowboy" collar
XII. References
- Kalsi, Kaufman and Hudson (2018) Crit Dec Emerg Med 32(10): 3-10
- Page (2004) South Med J 97:766-9 [PubMed]
- Nissen (1996) Physician Sportsmed 24:57-64 [PubMed]