Tuesday, December 23, 2008

Brachial plexus injuries in sports

Cervical nerve pinch syndrome, a neurapraxia of the brachial plexus, is a common occurrence in contact games. The more serious injury, brachial plexus axonotmesis, has received little attention in the literature. Acute brachial neuropathy is an uncommon etiology of shoulder pain and disability. It can, however, present in association with athletic activity and therefore must be included in the differential diagnosis of athletes with such symptomatology.
Findings that should alert the examiner to the possible presence of acute brachial neuropathy include 1) onset with non-contact as well as contact sports, 2) rather acute onset of pain without specific inciting trauma, 3) persistent, often severe pain that continues despite rest, 4) patchy brachial plexus and/or peripheral nerve involvement, and, 5) dominant arm predominance of symptoms and signs.
Electromyography and nerve conduction studies often can confirm the diagnosis. Treatment begins with rest and continues through a rehabilitation phase. Follow up of athletes with acute brachial neuropathy discloses that weakness may persist in the affected muscles. Absolute strength parity may be difficult to achieve, so permission to participate in athletics must be given on a case by case basis. These brachial plexus axonotmesis injuries may initially present as a cervical nerve pinch syndrome. All significant or repeated cervical nerve pinch injuries should be reexamined at 2 weeks. Those patients with axonotmesis should not be allowed to return to competi tion until they have achieved normal strength in the involved muscles and the electromy ogram shows no signs of active denervation.

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