Orthopedics Today Hawaii

Orthopedics Today Hawaii

Issue: February 2012
February 01, 2012
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Rule out more serious spine or cord trauma before diagnosing nerve pinch injuries

Issue: February 2012
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John D. Kelly IV, MD
John D. Kelly IV

WAILEA, Hawaii – To properly diagnosis nerve pinch injuries, or stingers, orthopedists need to rule out more serious spine or cord trauma first, said a presenter at Orthopedics Today Hawaii 2012, here.

“Concomitant lower extremity or bilateral symptoms, or ‘burning hands’, equals cord injury,” John D. Kelly IV, MD, said. “Neck tenderness, stiffness or apprehension of cervical motion may indicate spine fracture or ligamentous injury .”

Kelly said that one of the most important parts of the diagnosis for the orthopedist is not only accessing what symptoms patients have, but also which symptoms patients do not have. Differential diagnoses include “dead arm syndrome,” occult fracture cervical spine, cervical disc herniation, cord neuropraxia and acute brachial neuropathy, known as Parsonage-Turner syndrome.

“That is so important because if you miss this, then you are really not helping your patient,” he said.

Radiographs are necessary if neck pain is present, and MRIs are necessary if there is a suspect cord injury, if symptoms are prolonged or if the orthopedist suspects disc herniation. He said that EMGs, however, do not help him in the diagnosis because they will remain abnormal for up to 2 years.

“Stingers are common, and one of the problems we see in sports medicine is that it is very much underreported,” he said.

Prevention methods include neck strengthening, trapezial strengthening and changing the tackling technique. Cervical orthoses, which limit extension and lateral deviation, higher and thicker shoulder pads and neck rolls may help curb recurrence, he said.

Reference:
  • Kelly JD IV. What is a stinger (or nerve pinch injury)? Evaluation, treatment and return to play. Presented at Orthopedics Today Hawaii 2012, Jan. 15-18. Wailea, Hawaii.
  • Disclosure: Kelly has no relevant financial disclosures.

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