Treatment of Burner's Syndrome with Brachial Plexus Nerve Root Avulsion and Pre-Ganglionic Damage
This protocol targets the most severe grade of Burner's syndrome: brachial plexus nerve root avulsion involving pre-ganglionic damage. The Grade IIIB pattern carries distinct clinical implications because it does not resolve through natural healing, requiring a structured management approach from the outset.
Clinical Scenario
Grade IIIB stingers are defined by nerve root avulsion with pre-ganglionic damage. This injury pattern is irrecoverable through the body's innate healing process. Surgical intervention is required to facilitate functional recovery, making early recognition and appropriate initial management critical.
Treatment Approach (partial)
Initial management focuses on pain control and conservative support of the cervical region, including physical measures. A procedural intervention targeting the cervical region may be considered in select cases, though it requires careful judgement given the anatomical risks involved. A defined observation window is incorporated before surgical decisions are finalised — the complete sequenced regimen is available via the link below.
References
DOI: 10.3390/app15073510
- The worst form is a Grade IIIB stinger, characterized by nerve root avulsion and pre-ganglionic damage.
- Grade III stingers are irrecoverable through the body's innate healing process and require surgical intervention to facilitate functional recovery.
- 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.
- The current suggestion is to wait 3 to 6 months to allow reinnervation and settle concomitant injuries that make surgery unfeasible.
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