Management

Management

Management of this injury begins with a thorough clinical examination. On the field exam may include motor weakness and sensory deficits. Weakness and paresthesia will persist while the pain is present but should resolve rapidly after the pain subsides. Keep in mind that the muscles most commonly affected are the supraspinatus, infraspinatus, deltoid and biceps. Elbow flexion and shoulder flexion usually return first, then shoulder rotation abduction will follow. Anaesthesia will appear to be patchy, and mostly present on the lateral shoulder. Neck pain and loss of motion are uncommon for true burners, and may represent cervical spine injury. Bilateral upper extremity burning may also be a sign of significant cervical spine injury.

On the field, if the athlete has no evidence of cervical injury, strength testing of the shoulder rotators, deltoid and biceps should be performed. When the athlete’s subjective pain and weakness have resolved, and there is no evidence of weakness on examination the athlete can be allowed to return to play. Please note that the athlete should be followed through the next week to assess any delayed symptoms. If delayed symptoms are present, the athlete should be examined by a sports medicine physician.

Many physicians feel that all athletes should be examined after their first stinger, with a complete cervical radiograph series taken. If the athlete’s symptoms have not resolved by two seeks post-injury, this designates a Grade II injury, and the athlete should be referred to have radiographs and an EMG at three weeks to identify any clinical pathology.

Grade I and II injuries should result in removal of the athlete form contact sports until symptoms and resistance to manual strength testing is normal. The athlete should be placed on a cervical and shoulder strengthening program as soon as tolerable following the injury. Return to normal sports is allowed when the athlete demonstrates normal strength and endurance in the affected shoulder. An EMG may not be an accurate criterion for return to sports. EMG can show persistent changes even with full strength return.

Upon return to competition football players should be fitted with a “neck roll” type device that restricts lateral flexion and posterior extension. Built-up or elevated shoulder pads will also assist with this protective measure. These additional pads should reduce the incidence of burners, but may not fully prevent them. Athletes who continue to suffer multiple burners should be allowed to continue participation only if no weakness is present. Strength loss should preclude continued participation.

Grade III injuries are treated in the same fashion as Grade I and II injuries. Return to contact sports is usually prohibited because of continued weakness.

Source: The Athlete’s Shoulder, Andrews & Wilk, 1994

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM