Neuropraxia

1. Epidemiology
   1. Occurs in contact sports
   2. Most common c-spine related injury in football
      1. Incidence as high as 65% per football player
2. Mechanism
   1. Neuropraxia of nerve roots or brachial plexus
      1. Cervical nerves pinched by extension-compression
      2. Brachial plexus stretched during block or tackle
      3. Most commonly affected at C5 and C6
   2. Older athletes
      1. Disc disease or other pathology in 94% of cases
3. Symptoms
   1. Sharp, burning pain in shoulder with Paresthesia
   2. Radiation into arm and hand
   3. Does not follow dermatomal distribution
4. Red flags (suggestive of serious Cervical Spine Injury)
   1. Persistent symptoms (especially >24 hours)
      1. Burners usually resolve in minutes
   2. Bilateral symptoms
   3. C-Spine range of motion diminished or painful
5. Management
   1. No contact sports until symptoms resolve
   2. Evaluate for associated head and neck injury
      1. See Cervical Spine Injury
      2. See Concussion in Sports
      3. Assess for Brachial Plexus Injury
   3. Symptom duration determines return to play
      1. Symptoms that resolve in minutes may return to play
         1. See return to play indications below
      2. Symptoms persist in 5-10% of cases
         1. Full evaluation needed if symptoms last >24 hours
   4. Return to play indications
      1. Symptoms resolved and
      2. No pain with cervical spine range of motion and
      3. Normal Neurologic Exam
         1. Normal strength exam
         2. Normal Sensory Exam
   5. Recurrent symptom evaluation
      1. Assess for Cervical Spinal Stenosis
6. Course
   1. Pain and Paresthesia resolves quickly, seconds-minutes
   2. Weakness may persist for days to weeks
   3. Persistent weakness or sensory changes beyond 2 weeks
      1. Suggests Brachial Plexus Injury
7. Prevention
   1. Isotonic Exercises for neck and shoulder
   2. Preventive equipment
      1. Neck roll
      2. "Cowboy" collar
8. References
   1. Page (2004) South Med J 97:766-9
   2. Nissen (1996) Physician Sportsmed 24:57-64