Stingers and Transient Paresis


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  • Chapter Synopsis

  • Cervical cord neurapraxia and stingers can create significant angst in players, coaches, families, and spectators. Avoidance of permanent injury is tantamount. Effective postinjury management of the injured athlete by medical personnel either on the field or in the hospital setting can reduce the risk of secondary neurologic injury. This chapter covers the mechanisms, examination, imaging, and management of stingers and transient paresis.

  • Important Points

  • Sporting events are the fourth most common cause of spinal cord injury and the second most common cause of spinal cord injury in the first 3 decades of life.

  • Football is associated with the highest number of direct catastrophic injuries for any sport reported and with a significant number of stingers or brachial plexus injuries.

  • Burners and stingers are injuries to the brachial plexus that typically result in unilateral arm symptoms.

  • Transient quadripareses are injuries to the spinal cord that usually cause bilateral extremity symptoms.

  • Return to play is controversial and should be individualized to the patient; however, neurologic deficits, length of symptoms, and static and dynamic imaging should be included in the decision-making process.

  • Prevention though coaching of proper techniques, in particular tackling and blocking in football, along with athlete education remains paramount.

Sporting events comprise the fourth most common cause of spinal cord injury, after motor vehicle accidents, violence, and falls. Additionally, sports injuries comprise the second most common cause of spinal cord injury in the first 3 decades of life, and 7% of all new cases of spinal cord injury are related to athletic activities. In the United States, football is one of the most popular sports, with more than 1.2 million high school participants during the 2001 to 2002 academic year. Approximately 200,000 individuals engage in college and professional play each year. Unfortunately, football is associated with the highest number of direct catastrophic injuries for any sport reported to the National Center for Catastrophic Sports Injury Research (NCCSIR), and it is also associated with a significant number of stingers or brachial plexus injuries. Other sports that have been implicated in spinal cord injuries include ice hockey, wrestling, diving, skiing, snowboarding, rugby, cheerleading, and baseball.

The NCCSIR characterizes catastrophic sports injury as “any severe spinal, spinal cord, or cerebral injury incurred during participation in a school/college sponsored sport,” and these injuries are further subdivided into direct or indirect. Direct injuries result from participation in the sport, such as trauma from a collision or impact, whereas indirect injuries arise from failure from exertion, such as heat stroke or arrhythmia. Indirect injuries are characterized by medical issues, which include cardiopulmonary diseases such as arrhythmias and hypertrophic cardiomyopathy. Concussions are currently not classified as catastrophic injuries by the NCCSIR, but they can cause lifelong disability.

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