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Noncatastrophic Cervical Spine Injuries

Noncatastrophic injuries include neuropraxia of the cervical root or brachial plexus (the “stinger” or “burner”), paracentral intervertebral disc herniation, stable fractures, spinal ligament injury, and intervertebral disc injury. These more common syndromes make up the majority of injuries encountered by sports medicine physicians.

Unilateral upper extremity involvement usually represents neuropraxia of a cervical nerve root or the brachial plexus. Many descriptions and explanations for this well-known “stinger” or “burner” phenomenon exist.

Foraminal compression of a nerve root from forceful neck extension and rotation toward the affected side are thought to be involved. Alternatively, traction (tensile forces) may injure the brachial plexus, resulting in a neuropraxia.

Direct compression of the upper trunk between the shoulder pad and the ipsilateral scapula has been reported. Again, the signs and symptoms include burning pain, weakness, or paresthesias in the shoulder girdle and arm. Neck tenderness usually is absent, and range of motion often is full.

Transient motor, sensory, and/or reflex deficit can occur, but these symptoms resolve within several minutes. Some athletes, however, may not gain full strength until 24 to 48 hours later. Although muscle weakness is variable, it is unlikely to represent permanent motor loss. The lifetime incidence of a “burner” in college football players has been reported to be 65%.

Paracentral disc herniation also can cause unilateral upper limb and neck symptoms associated with nerve root compression. Causes range from high-energy impact loading to a minor twisting injury to the neck.

Typically, a tear in the posterolateral aspect of the annulus fibrosus allows the nucleus pulposus to protrude posteriorly. Monoradiculopathy, paresthesias, and/or weakness in the upper extremity often are present. Careful, initial evaluation of the nerve symptoms and deficits should allow a presumptive determination of the affected disc level. Spasm and neck pain almost always are present.

Localized neck symptoms usually signify more minor injuries: stable fractures, spinal ligament injuries (cervical sprains), or intervertebral disc injury. Stable fractures of the anterior column generally are secondary to compressive forces.

In contrast, fractures of the posterior elements typically result from a hyperextension injury vector. During minor spinal ligament injuries or intervertebral disc injuries, the stability of the spinal column is not compromised; therefore, the integrity of the neural elements is maintained.

Typically, however, these injuries present with tenderness to palpation over the affected area and limited range of motion.The diagnostic algorithm for initial evaluation of an athlete with a suspected injury to the cervical spine.

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