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For any significant neck injury, radiography of the cervical spine should be performed, including AP, lateral, bilateral oblique, lateral flexion, and extension views. Imaging may be deferred in cases of recurrent burners in which symptoms resolve, but radiography should be considered for any athlete with first-time symptoms. Radiographs should be evaluated for loss of cervical lordosis, spinal stenosis, foraminal stenosis, and instability.

Meyer et al.It has reported that players with a Pavlov ratio of less than 0.8 have an increased risk of experiencing a burner. It should be noted that although athletes with a Pavlov ratio of less than 0.80 demonstrate a higher risk of recurrent stingers, but not of first-time stingers, the level of stenosis did not correlate with the level of stinger symptoms.

Magnetic resonance imaging can be helpful in identifying nerve root injuries. In one series, 11 patients with MRIs demonstrating root avulsion had the diagnosis confirmed during surgery, with no false positives. Edema in the spinal cord was suggestive of root avulsion. The sensitivity of MRI to detect nerve root avulsions has been reported to be from 81% to 92.9%.

Also, MRI can rule out structural pathologies, such as herniated discs, ligamentous injuries, facet injuries, and nondisplaced fractures. Magnetic resonance neurography remains investigational, however, and its role in brachial plexus problems is still being evaluated.

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