Case Study: The Effects of Cervical Bony Abnormalities on Recurrent Brachial Plexus Stingers in a Collegiate Division I Football Player

Kristen Bartiss

Abstract


Background: Brachial plexus injuries, also known as stingers, are prevalent in contact sports and usually result in neuropraxia lasting for a few seconds to minutes. A 21-year-old Division I sprint football player of Asian descent with a bony abnormality at the C5-C6 level sustained a brachial plexus injury when tackling an opponent on September 1, 2012, resulting in neurological symptoms lasting for one week. He complained of paresthesia radiating from his left shoulder to his fingertips, as well as slight pain at the C5-C6 level with left lateral flexion and rotation. An extensive previous history of cervical spine trauma resulted in thorough examination of the athlete’s case. A week later, an additional brachial plexus injury was sustained, and the athlete was referred to an orthopedic surgeon for further diagnostic imaging and evaluation. Examination showed a negative Spurling’s test, normal x-rays, and an abnormal presence at the C5-C6 vertebral level on MRI. The athlete was cleared to RTP when s/s ceased, and after diagnostic imaging was conducted and the anatomical anomaly was deemed benign. Differential Diagnosis: Brachial plexus stinger, chronic brachial plexus syndrome, posterior longitudinal ligament calcification or uncinate process bone spurring predisposing to stingers. Treatment: After ROM and MMTs were restored and the anatomical abnormality was deemed benign, the athlete returned to competition with the use of a cowboy collar. Initial treatment was ice, rest, NSAIDs and thermotherapy to modulate pain. The athlete was placed on a rehabilitation plan and instructed to perform cervical ROM and strength exercises and followed a 9 minute shoulder exercise protocol.  He also performed functional exercises and received instruction on proper tackling and blocking techniques before RTP. Uniqueness: Although brachial plexus injuries are common in football, neurological s/s generally subside within a short period of time. The athlete in this case study had evidence of either a PLL calcification, common in the Asian population, or a uncinate process spurring; both of which lead to spinal stenosis and thus an increased risk of sustaining a brachial plexus injury. This case is unique, because measurements of the spinal canal were WNL, yet s/s persisted. Conclusions: Previous history of numerous brachial plexus injuries and a traumatic cervical spine injury were believed to be attributed to a structural abnormality at the C5-C6 vertebral level. The origin of the abnormality is unknown, and the abnormality was determined to pose no major threat to the athlete. Although RTP was controversial, this athlete was allowed to be treated symptomatically, and cleared for full RTP.


Keywords


Stingers, Stenosis, Brachial Plexus, PLL, Football

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