A BRACHIAL PLEXUS INJURY (‘STINGER’ INJURY IN RUGBY UNION)
By Barney Kenny, MCSP, MPhty (Sports)
There are many models for rehabilitation but key components in cervical spine reha- bilitation are: 1. Prevent re-occurrence 2. Increase flexibility of the cervical spine and surrounding soft tissue 3. Increase the functional strength of the stabilising muscles of the respective joints 4. Improve proprioception of the cervical spine 5. Correct abnormal mechanics 6. Teach functional specific exercise rela- tive to the individual’s sport 7. Provide psychological support
1. Prevention Prevention of injury in any sport relies on the identification of the extrinsic and intrinsic predisposing factors of injury. In rugby union, statistics have identified the scrum and the tackle situation as extrinsic factors causing injury to the cervical spine. Potential intrinsic risk factors to the cervi- cal spine are cervical spine canal stenosis. In 1987, Pavlov and Torg initiated a method of measuring the diameter of the spinal canal (1).
A vertebral canal/vertebral body ratio under 0.8 was defined as ‘significant spinal steno- sis’. Torg’s work was based on studies docu- mented from the National Football Head and Neck Injury Register in the US. Torg and his colleagues aimed to produce guide- lines for safe participation in collision sports (Fig.1a).
These guidelines could be used to assist in the medical decision of the ‘return to play’ situation if a player had received a cervical spine injury. If a player had an abnormal ratio, further investigations would be war- ranted. It is worth noting that an abnor- mally large vertebral body might affect the ratio even though the spinal canal may not be stenotic - thus giving a false positive reading (2).
As mentioned in the previous article it is important to understand the severity of the brachial plexus injury which is commonly referred to as whiplash injury, or in rugby is known as a ‘stinger’ injury. How you distinguish between the ‘stinger‘ injury and trauma to the cervical spine is covered on p17 in the differential diag- nosis table. This article focuses on the subject of rehabilitation.
Ratio = a/b
Figure 1: Method used for measuring ratio of spinal canal to vertebral body and the effect of cervical canal stenosis causing a ‘pincer-like’ mechanism causing cervical cord neuropraxia (Reproduced from Torg J and Ramsey Emrhein 1997 (1))