Brachial Plexus Injury in Sports Medicine Clinical Presentation

Updated: Oct 31, 2022
  • Author: Thomas H Trojian, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Presentation

History

Commonly, the athlete may complain or describe burning and/or sensation of numbness in the proximity of the neck, shoulder, or upper extremity. The following symptoms usually follow a blow to the head, trapezius, or shoulder:

  • "Dead arm"

  • Pain in neck

  • Burning sensation between neck and shoulder

  • Dysesthesias

  • Affected extremity may feel weak or heavy

  • Paresthesias

Symptoms can last anywhere from a few seconds to weeks, depending on the extent of injury. Numbness in both upper extremities should alert the physician to a possible cervical cord injury.

Next:

Physical Examination

The physician should keep a high index of suspicion for potential cervical fracture and/or cord injury in the face of an athlete with any degree of altered level of consciousness. In the alert and awake athlete, a full neurologic examination is warranted.

  • Assessment of immediate mental status

  • Cervical nerve root assessment (motor and sensory)

  • Tenderness over Erb point

  • Spurling test

    • This test is best performed once cervical spine and neurologic assessment has been completed and no risk of potential spine injury is present.

    • The test is performed by extending the cervical spine with the head rotated toward the affected shoulder while cautious, but firm, axial loading is administered.

    • The purpose of the Spurling test is to reproduce the symptoms of a brachial plexus injury by manipulation of the neck. A positive Spurling test successfully reproduces the patient's symptoms.

  • On-field management and assessment of the injury is determined at the time of injury and should include the following:

    • Specific symptoms

    • Durations of symptoms

    • Cervical ROM within pain threshold when no suspicion of cervical fracture is present

    • Assessment for motor deficits

    • Grip strength

    • Early mobilization of the affected region

    • Icing of the affected region with care not to ice the peripheral nerve

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