Stingers Flashcards
What are the absolute contraindications for an athlete to return to play after a stinger?
- More than 2 previous episodes of transient quadriparesis/quadriplegia
- clinical history/findings with confirmation of cervical myelopathy
- continued neck discomfort, decreased ROM or any evidence of a neurologic deficit from baseline after a c-spine injury
Describe a stinger:
A temporary episode of UE dysesthesia with motor weakness
What are the 3 different mechanisms of a stinger?
- stretch/traction injury to the brachial plexus
- extension of cervical spine resulting in nerve root compression
- direct blow resulting in injury to the brachial plexus
What are the most common nerve roots affected?
C5 and C6
What is the most common truck affected?
Upper trunk:
Supraspinatus
Deltoid
Biceps
What is the Torg ratio?
Torg ratio less than ___ is 3x greater risk of suffering a stinger
Developed to evaluate congenital cervical spine stensois
less than 0.8
Return to play criteria after 1st stinger?
- complete symptom resolution
- full ROM
- normal spine on XRay
If sx persist beyond 2-3 weeks what should be ordered?
EMG
Erb’s Palsy:
Nerve root:
Deformity:
Upper root (C5-C6)
Deformity: arm hangs by side, adducted and IR
AKA “policeman’s tip hand”
Klumpke:
Nerve root:
Deformity:
Lower root (C8-T1)
Deformity: claw hand
Neuropraxia
Transient episode of motor/and or sensory paralysis
Resolves in mins to hours, but can last up to 6-8 weeks
What would you notice if the transverse ligament was disrupted?
Increased anterior translation of C1 and C2
Brown-Sequard Syndrome
Hemi-section of spinal cord
- loss of ipisilateral motor function
- contralateral spinothalamic
pain & temperature
When can a player return to game:
After 1st stinger:
After 2nd stinger:
After 3rd stinger:
After 1st stinger:
- return to same game once sx free & full ROM
After 2nd stinger:
- sit out remainder of same game, return next game once sx free & full ROM
After 3rd stinger:
- remove from game, advanced imaging & clearance from physician
