Brachial Plexus Injuries

• Chapter 11 • Athletic Injury Assessment

371 • C5-T1nerve roots – Upper trunk:C5-C6 – Middle trunk: C7 – Lower trunk: C8-T1 .Clinical Anatomy p.11-5. .371 • Innervation for upper extremity • Levels--fig.

386 . p.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. 11-16.Brachial Plexus Pathology —p. 385 • Mechanisms: – – – – acute onset traction/stretch compression fig. 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 .

387 • Box 11-5. p.387 • Assessment: – Brachial plexus traction test-• p.Brachial Plexus Pathology p. 387 • 2 possible results – Possibly (+) Spurling test – Dermatome testing .

• C8: finger flex. • T1: finger abd. wrist ext • C7: elbow ext.. wrist flex. ./ER • C6: elbow flex..Brachial Plexus Myotomes • C5: shoulder 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 .

5mm20mm(C3-C6) – CSF coats and cushions spinal cord – small canal or large cord may = stenosis – Medical imaging used to measure risk .Cervical Stenosis – Cervical spinal canal usu. 14.

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

8-1.2) then CT/MRI • whole spine imaging? .Cervical Stenosis: Management – Symptoms dictate workup – Imaging: • x-rays to determine Torg ratio • If Torg ration outside of NL ranges (.

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 .