Traumatic neuropathy: stingers

Elman L, McCluskey L. Occupational and Sport Related traumatic neuropathy. The Neurologist 2004; 10:82-96 The burner or stinger is the most common sports related peripheral nerve injury and is caused by injury either to the C5-6 root or the superior trunk of the brachial plexus. Multiple postulates of causes though the most commonly proposed is downward displacement of the shoulder from the neck during tackling in a shoulder down position. The Torg ratio is a measure of spinal stenosis determined by cervical spine x rays does not predict stingers but does predict recurrence. Accordingly high school and college players usually have as the cause stretch of the brachial plexus whereas professionals with recurrent stingers have spinal stenosis. Acute disc herniation is not a cause however. Symptoms are immediate pain, numbness and paresthesias that last minutes. Weakness if it occurs may persist. Neck pain is not common. If sensory symptoms predominate its usually due to compression of the DRG within the neural foramen. Exam of the neck shoulder and C spine looking for point tenderness or fracture is done. Any neurologic deficit requires abstention from play. Muscle weakness at 72 hours predicts an abnormal EMG. On EMG, spontaneous activity in the paraspinals helps to localize to the nerve root, and sensory findings with a normal SNAP amplitude suggest localization in the forament with compression of the DRG. Decreased SNAP amplitude suggests a brachial plexus localization. Return to play is not determined by normalization of EMG. Persisting pain, restricted ROM, or neurologic deficit requires PT prior to return to play, for strengthening of weakened muscles as well as stabilization of brachial plexus and restoration of the normal cervical lordosis. Education of tackling technique and use of proper equipment is part of rehabilitation.