Neck blog series part 5: Brachial Plexus Pathology:

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What is the Brachial Plexus?



Brachial Plexus:  C5 – T1
7 cervical vertebrae
8 cervical nerves:
1st 7:  exit above the corresponding vertebrae
C8:  exits below the 7th cervical vertebrae

What is Brachial Plexus Pathology?



Brachial Plexus Neuropraxia, which is commonly called a “Burner” or “Stinger”
Definition: 
“Transient brachial plexopathy involving the upper trunk”
“Temporary episode of unilateral upper extremity burning dysethesia with or without motor weakness”
“Stinger” Tingling that occurs in upper extremity after injury.

How much of a problem is Brachial Plexus Pathology:


Epidemiology:  (specific studies)
50% of a Division 1 American football teams had 1 or more burners per season.
65% of Division 3 players (201) experienced more than 1 burner during their careers. 
70% reported additional burners that they did NOT report.
Increased occurrence with defensive players due to more tackling.

What are the common symptoms of Brachial Plexus Pathology?


Numbness and burning of the entire arm, hands and fingers,
Sensation loss over dermatomes:


Complete transient paralysis of affected nerves,
Tenderness over the brachial plexus.

Grading:
Grade 1 (Neuropraxia):  Transient signs and symptoms. Last from a few minutes up to 2 weeks.
Grade 2 (Axonotmesis):  Significant sensory and motor deficits. Lasts for more than 2 weeks and less than 6 months.
Grade 3 (Neurotmesis):  Symptoms last 6 months to a year.

What causes Brachial Plexus Pathology?

Either:

Stretch of the brachial plexus:
Head forced laterally while opposite shoulder is depressed (commonly from tackling in rugby).
Spinal levels C5 and C6 are most commonly affected.

Nerve root compression:
Combination of neck hyperextension and ipsilateral lateral flexion,
Nerve roots impinged between the vertebrae,
Spinal stenosis – increases the risk.

Compression of brachial plexus:
Direct blow to Erb’s point (shoulder pads compress plexus)

How do you diagnose Brachial Plexus Pathology?

Inspection:
Athlete shakes arm/hand in attempt to regain feeling
Inspect cervical spine for abnormality (fracture/dislocation)

Palpation:
Cervical spine, Clavicle, humerus, scapula, sternum, ribs, Sternocostal joints, Acromioclavicular joints and  Glenohumeral joints.
Shoulder musculature

Functional Testing:
Active and passive ROM (Range of Movement) all neck and shoulder movements.
Resisted ROM – can be performed in conjunction with myotome (muscle strength) check.
Key muscles tested:  deltoid, external rotators, biceps brachii.

Neurological Screening:
Upper quarter sensory/motor testing

Special Tests:
Brachial plexus stretch test

Spurling test

Cervical compression and distraction tests:



What is my prognosis?

Time depends on severity of injury. (see Grades 1, 2 and 3 above)

Return to Play Criteria:
Full, pain-free active and passive ROM in the cervical spine,
Full, pain-free neck strength against resistance,
Full strength of all shoulder and arm movements,
Normal sensation in all dermatomes.

If you need any further information or would like to book an appointment then call Hawkes Physiotherapy on 01782 771861 or 07866195914

WWW.HAWKESPHYSIOTHERAPY.CO.UK

Comments

  1. Unknown13 May 2019 at 23:21

    hey thanks for the information ! I'm playing Rugby and i was wondering what kind of exercise can i do for stretching the spasm muscle et training the other muscle in prevention ? Thanks

    ReplyDelete

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