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Evaluation-Physical Examination

The athlete with a burner may come off the field shaking his or her arm and hand. If significant neck pain exists, or when neurological symptoms involve two or more extremities, cervical spine precautions should be taken with the athlete until the player is cleared from having a cervical spine injury.

A typical examination of a burner includes observation and palpation of the neck region for tenderness, swelling, or deformity. The athlete may hold the neck flexed to alleviate pressure on the cervical root. Palpation around the affected nerve root may cause local pain and aggravate symptoms.

The shoulder, clavicle, sternoclavicular, and acromioclavicular joints also should be evaluated for deformity and swelling to rule out any other injury. The range of motion in the neck should be assessed by observing active movement through full motion, including flexion, extension, lateral bending, and rotation.

If the range of motion is not significantly restricted and little apprehension is noted with movement of the neck, a Spurling maneuver may be performed by gently, laterally bending and extending the head with mild downward pressure. A positive sign is reproduction of symptoms down the arm.

In cases of traction injury, lateral bending of the neck away from the symptomatic side may cause stretching of the brachial plexus, reproducing symptoms. A careful examination of sensation and motor strength should be performed on the upper extremities. The most common pattern of symptoms is over the lateral aspect of the arm, along the radial nerve distribution (C5–C6).

Special attention should be taken to assess upper trunk function (deltoid, rotator cuff, and biceps) to evaluate the burner and recovery from the injury and to assess the lower trunk (ulnar nerve) to rule out other significant injuries that may be masquerading as a burner. A Tinel sign may be elicited by tapping in the region of the Erb point (superior and deep to the medial clavicle, just lateral to the sternocleidomastoid muscle). With a mild injury, symptoms often resolve quickly (within minutes).

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