Management of Stinger/Burners

Transcription

1 Management f Stinger/Burners ALLINA HEALTH SPORTS MEDICINE CONFERENCE 2018 Cmmn injury in sprts American Ftball is by far the mst cmmn with up t 70% f cllege ftball players reprting having a stinger Wrestling Sccer, skiing AllinaHealthSystems 1

2 Mechanisms f injury A. Tractin B. Direct cmpressin f plexus C. Cmpressin f cervical facets Peripheral nerve injury is ften graded using Seddn's classificatin Grade I Neurapraxia disruptin f nerve functin invlving demyelinatin axnal integrity is preserved, and remyelinatin fllws within three weeks EMG is typically nrmal. Grade II Axntmesis axnal damage and Wallerian degeneratin ccur electr-cnductin changes n EMG within tw t three weeks. Grade III Neurtmesis cmplete nerve transectin permanent nerve damage AllinaHealthSystems 2

3 Burners typically represent a grade I r II injury. Grade III peripheral nerve injuries are rare in sprts and are nt characteristic f burners. Stingers/burners typically affect the C5 +/- C6 nerve rts r the upper trunk f the brachial plexus Assessment HPI inquire abut past histry r zingers EXAM AROM/PROM Neur DTRs/mtr/sensry Orth - TOS, Spurling s Palpatin trigger pints- referral pattern Mtin palpatin f cervical spine, humeral head, scapula, 1 st rib, clavicle DDX cnsider x-ray if cnsidering bny invlvement cnsider MRI with neur findings AllinaHealthSystems 3

4 Prtect Management remve frm play until full pain-free ROM n neurlgic symptms and nrmal strength Chirpractic Care Gals Restre balance f the C-spine and shulder/trunk Optimize spinal functin t reduce nerve entrapment Return t play as sn as pssible Chirpractic care Manipulatin t release jint adhesins in C/T/1 st rib/clavicle/scapula/humeral head Cervical tractin t release jint adhesins Mtin assisted myfascial release t reduce muscle adhesins Therapeutic mdalities Optimize neurnal/sft tissue healing Infrared/red light therapy (lw level laser, cld laser) - alng injured area Phtbimdulatin - increased ATP prductin, decrease xidatin AllinaHealthSystems 4

5 Chirpractic management Nutritinal supprt ALA 600 mg daily Omega 3 FA - B vitamins - especially B9, B12 (methyl cbalamin sublingual) Vitamin D 2 Advantages f Chirpractic Restre nrmal jint range f mtin (AROM/PROM) Repsitin r realign a jint - nrmal distributin f frces and stresses Reduce pain Reflexgenic effects that inhibit r facilitate muscle tne r stretch reflex (muscle guarding) Prpriceptive effects t imprve pstural and kinesthetic awareness Effective and widely used technique in injury rehabilitatin AllinaHealthSystems 5

6 EBM randmized cntrlled trial Brachial plexus, manipulatin Demnstratin Prne/supine/seated cervical manipulatin Prne/Supine 1 st rib manipulatin Anterir/psterir thracic manipulatin Lng axis distractin f humeral head Internal/external rtatin f scapula (prne) AllinaHealthSystems 6

7 Resurces A randmized clinical trial f manual therapy fr cervic-brachial pain syndrme -- a pilt study Allisn GT, Nagy BM and Hall T Manual therapy, 2002, 7(2), 95Online Publicatin Date: 2003 Neural Regen Res May; 11(5): Turk Neursurg. 2016;26(6): di: / JTN J Neursci Jan 11;32(2): di: /JNEUROSCI AllinaHealthSystems 7