Treatment of Burner's Syndrome in Axonotmesis of the Brachial Plexus or Cervical Nerve Roots
This protocol applies to Burner's syndrome presenting in the context of axonotmesis — a structurally significant nerve injury that requires a more deliberate management strategy than milder forms of the condition.
Clinical scenario
Axonotmesis of the brachial plexus or cervical nerve roots represents a Grade II injury in which the axon itself is severed and undergoes Wallerian degeneration. This distinguishes it from neuropraxic stingers and carries a more prolonged and variable recovery course.
Management approach
Treatment centres on conservative measures — including pain control and physical rehabilitation — combined with serial electrodiagnostic monitoring to track nerve recovery over time. Additional interventional options may be considered in carefully selected cases.
The complete structured regimen is available via the protocol below.
Treatment goals
Resolution of neurological deficit with recovery of upper extremity sensory and motor function. Initial improvement is typically expected within two weeks, with maximum recovery possible over a substantially longer period.
References
- Axonotmesis, or Grade II Stinger, refers to a more extensive injury where the axon of the nerve is severed and undergoes Wallerian degeneration.
- Pain control, rest and physiotherapy, serial monitoring with electrodiagnostic studies, and imaging (MRI, radiographs).
- For athletes who sustain Grade I and II injuries, the mainstays of treatment are pain control, reduction of inflammation, physical rehabilitation, and prevention of recurrence.
- Pain is controlled with rest, analgesics, and a cervical collar.
- Cervical region epidural injections can also be used; however, utmost caution should be exercised because of the risks of traumatizing the cord directly during the procedure or indirectly due to the high pressure from administering medication in a narrowed and compromised canal.
- This type of injury can have a longer-lasting effect on the neurologic deficit, usually taking up to 2 weeks to resolve and a maximum of a year and a half to recover.
DOI: 10.3390/app15073510
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