Peripheral Nerve Injuries Attributable to Sport and Recreation

Many different sports and recreational activities are associated with injuries to the peripheral nervous system (PNS). Although some of those injuries are specific to an individual sport, other peripheral nerve injuries occur ubiquitously within many sporting activities. This review of sport-specific PNS injuries should assist in the understanding of morbidity associated with particular sporting activities, professional or amateur. Proper recognition of these syndromes can prevent unnecessary diagnostic testing and delays in proper diagnosis. The sports most commonly associated with peripheral nerve injuries are likely football, hockey, and baseball, but many other sports have unique associations with peripheral nerve injury. This article should be of assistance for the neurologist, neurosurgeon, orthopedic surgeon, physiatrist, sports medicine doctor, and general physician in contact with athletes at risk for neurologic injuries.

The scope of sports-related injuries is extensive and most commonly involves the musculoskeletal system. There are numerous and varied peripheral nervous system (PNS) injuries that depend on the nature of the sporting activity, age of the participants, and intensity of play, however. The type of sport may vary from recreational games, such as bowling or lawn darts, to spectator sports, such as professional football. The physician may be confronted with symptoms and signs reflecting injury to several neurologic levels, including the peripheral nerve, spinal roots, and brachial plexus. The recognition of specific injury and its relation to specific sporting activities may assist the physician with the rapidity of diagnosis, cessation of offending activities, and possible therapy.

This article highlights injuries to peripheral nerves attributable to particular sporting or recreational activities. As possible, only those peripheral nerve injuries associated with a clear clinical presentation or supporting laboratory data have been included. Peripheral nerve injuries have been classified based on the sporting or recreational activity, although tables are provided to classify by individual peripheral nerves and by individual sporting activities. Some peripheral nerve injuries have been covered in other articles in this issue and have not been reiterated here. Sporting activities associated with known peripheral nerve injuries are listed in Box 1 , whereas peripheral nerve injuries are organized by sport in Box 2 and anatomically in Box 3 .

Box 1

Archery
Arm wrestling
Australian rules football
Auto racing
Ballet dancing
Baseball
Basketball
Bicycling
Bodybuilding
Bowling
Boxing
Cheerleading
Cross-country skiing
Dancing
Football
Frisbee
Golf
Gymnastics
Handball
Hiking
Ice hockey
Judo
Karate
Kickboxing
Mountain climbing
Racquetball
Rodeo
Running
Scuba diving
Shooting
Skating
Snowmobiling
Soccer
Softball
Squash
Surfing
Swimming
Tae kwon doe
Tennis
Volleyball
Weightlifting
Wheelchair basketball
Wrestling
Yoga

Sporting activities associated with PNS injury categorized by sport

Box 2

Archery
- Digital nerve compression
- Median neuropathy at wrist
- Median neuropathy at pronator teres
- Long thoracic nerve palsy
Arm wrestling
- Radial nerve palsy
Auto racing
- Brachial plexopathy
- Sciatic neuropathy
- Peroneal neuropathy
Ballet dancing
- Suprascapular neuropathy
- Femoral neuropathy
- Peroneal neuropathy
- Sural neuropathy
- Dorsal cutaneous neuropathy
- Morton’s neuroma
Baseball
- Suprascapular neuropathy
- Radial neuropathy
- Ulnar neuropathy
- Musculocutaneous neuropathy
- Median neuropathy at pronator teres
- Thoracic outlet syndrome
- Axillary neuropathy with quadrilateral space syndrome
- Digital neuropathy at thumb
- Brachial plexopathy (pitcher’s arm)
Basketball
- Suprascapular neuropathy
- Stinger
- Median neuropathy at the wrist (wheelchair athletes)
- Ulnar neuropathy at the wrist (wheelchair athletes)
Bicycling
- Ulnar neuropathy at Guyon’s canal
- Ulnar neuropathy at the elbow
- Median neuropathy at the wrist
- Pudendal neuropathy
- Posterior cutaneous nerve of the thigh neuropathy
- Sciatic nerve palsies (unicyclists)
Bodybuilding/weightlifting
- Ulnar neuropathy at the deep motor branch
- Ulnar neuropathy at flexor carpi ulnaris
- Ulnar neuropathy at the deep palmar branch
- Ulnar neuropathy at the elbow
- Posterior interosseous neuropathy
- Medial pectoral neuropathy
- Suprascapular neuropathy
- Median neuropathy at the wrist
- Long thoracic neuropathy
- Lateral antebrachial cutaneous neuropathy
- Musculocutaneous neuropathy
- Femoral neuropathy
- Thoracodorsal neuropathy
- Dorsoscapular neuropathy
- Stinger
- Rectus abdominis syndrome with rhabdomyolysis
Bowling
- Digital neuropathy of the thumb
Boxing
- Stinger
Cheerleading
- Digital neuropathy
- Median neuropathy at the palmar branch
Football
- Stinger
- Upper trunk brachial plexopathy
- Radiculopathy of C5, C6, L5, or S1 roots
- Axillary neuropathy with or without dislocated shoulder
- Suprascapular neuropathy
- Ulnar neuropathy at the elbow
- Median neuropathy at the wrist
- Long thoracic neuropathy
- Radial neuropathy
- Thoracic outlet syndrome
- Iliohypogastric neuropathy
- Peroneal neuropathy with knee dislocation
- Sciatic nerve (hamstring syndrome)
Frisbee
- Posterior interosseous neuropathy
Golf
- Median neuropathy distal to wrist
- Carpal tunnel syndrome (CTS)
- Ulnar neuropathy at flexor carpi ulnaris
Gymnastics
- Posterior interosseous neuropathy
- Lateral femoral cutaneous neuropathy
- Femoral neuropathy
Handball
- Handball goalie’s elbow
Hockey
- Stinger
- Axillary neuropathy
- Tibial neuropathy attributable to tarsal tunnel syndrome
- Peroneal neuropathy
In-line skating, rollerskating, and skateboarding
- Superficial peroneal neuropathy
Judo, karate, and kickboxing
- Morton’s neuroma of a plantar nerve
- Ulnar neuropathy at trauma site
- Axillary neuropathy at trauma site
- Spinal accessory neuropathy at trauma site
- Long thoracic neuropathy at trauma site
- Peroneal neuropathy at trauma site
Mountain climbing, hiking
- Tarsal tunnel syndrome
- Rucksack paralysis—brachial plexopathy (upper and middle trunks)
- Suprascapular neuropathy
- Axillary neuropathy
- Long thoracic neuropathy
Rugby/Australian rules football
- Axillary neuropathy
- Obturator neuropathy
Running
- Peroneal neuropathy
- Lateral femoral cutaneous neuropathy
- Tibial neuropathy at the tarsal tunnel
- Posterior tibial neuropathy
- Morton’s neuroma of a plantar nerve
- Interdigital neuropathies
- Plantar neuropathies
- Calcaneal neuropathy
- Sural neuropathy
- Superficial peroneal neuropathy
- Saphenous neuropathy
- Rhabdomyolysis
Scuba diving
- Lateral femoral cutaneous neuropathy
Shooting
- Long thoracic neuropathy
Skiing, snowboarding, sledding, and ski jumping
- Femoral neuropathy (cross-country skiing)
- Ulnar neuropathy (cross-country skiing)
- Brachial plexus injury (snowboarding)
Snowmobiling and all-terrain vehicle riding
- Brachial plexopathy
- Ulnar neuropathy at Guyon’s canal
Soccer
- Peroneal neuropathy
Surfing
- Common peroneal neuropathy
- Saphenous neuropathy
Swimming
- Thoracic outlet syndrome
Tennis/racquetball
- Posterior interosseous neuropathy at the arcade of Frohse
- Suprascapular neuropathy
- Long thoracic neuropathy
- Lateral antebrachial cutaneous neuropathy
- Radial neuropathy secondary to fibrous arches at lateral head of triceps
- Digital neuropathy
- Superficial radial neuropathy attributable to constrictive sweatband
- Thoracic outlet syndrome
Volleyball
- Suprascapular neuropathy
- Axillary neuropathy
- Long thoracic neuropathy
Wrestling
- Stinger
- Brachial plexopathy
- Axillary neuropathy
- Ulnar neuropathy
- Median neuropathy at the wrist
- Long thoracic neuropathy
- Suprascapular neuropathy
Yoga
- Sciatic neuropathy

PNS injuries by sport

Box 3

Digital nerves
- Archery
- Baseball
- Bowling
- Cheerleading
- Tennis
Median nerve
- Wrist
  - Archery
  - Basketball (wheelchair)
  - Bicycling
  - Bodybuilding/weightlifting
  - Football
  - Golf
  - Wrestling
- Palmar branch
  - Cheerleading
  - Golf
- Pronator teres
  - Archery
  - Baseball
Ulnar nerve
- At the elbow
  - Baseball
  - Bicycling
  - Bodybuilding/weightlifting
  - Judo, karate, and kickboxing
  - Cross-country skiing
  - Wrestling
- At the wrist
  - Basketball (wheelchair)
  - Bicycling
  - Football
  - Cross-country skiing
  - Snowmobiling
- At flexor carpi ulnaris
  - Bodybuilding/weightlifting
  - Golf
- At the deep motor branch
  - Bodybuilding/weightlifting
Radial nerve
- Arm wrestling
- Baseball
- Football
- Tennis/racquetball
Posterior interosseous neuropathy
- Bodybuilding/weightlifting
- Frisbee
- Gymnastics
- Tennis/racquetball
Superficial radial nerve
- Tennis/racquetball
Axillary nerve
- Baseball
- Football
- Hiking
- Hockey
- Judo, karate, and kickboxing
- Rugby
- Volleyball
- Wrestling
Spinal accessory nerve
- Judo, karate, and kickboxing
Musculocutaneous nerve
- Bodybuilding/weightlifting
- Baseball
Lateral antebrachial cutaneous neuropathy
- Bodybuilding/weightlifting
- Tennis
Thoracic outlet syndrome
- Baseball
- Football
- Swimming
- Tennis
Long thoracic nerve
- Archery
- Bodybuilding/weightlifting
- Football
- Judo, karate, and kickboxing
- Hiking
- Shooting
- Tennis/racquetball
- Volleyball
- Wrestling
Thoracodorsal neuropathy
- Bodybuilding/weightlifting
Dorsoscapular nerve
- Bodybuilding/weightlifting
Suprascapular nerve
- Ballet dancing
- Baseball
- Basketball
- Bodybuilding/weightlifting
- Football
- Hiking
- Tennis/racquetball
- Volleyball
- Wrestling
Medial pectoral neuropathy
- Bodybuilding/weightlifting
Brachial plexus
- Auto racing
- Baseball
- Football (upper trunk)
- Hiking (upper and middle trunk)
- Snowmobiling
- Snowboarding
- Wrestling
Stinger
- Basketball
- Bodybuilding/weightlifting
- Boxing
- Football
- Hockey
- Wrestling
Cervical radiculopathy
- Football
Femoral nerve
- Ballet dancing
- Bodybuilding/weightlifting
- Gymnastics
- Cross-country skiing
Obturator nerve
- Rugby/Australian rules football
Peroneal nerve
- Auto racing
- Ballet dancing
- Football
- Hockey
- Judo, karate, and kickboxing
- Running
- Soccer
- Surfing
Pudendal nerve
- Bicycling
Iliohypogastric nerve
- Football
Sciatic nerve
- Auto racing
- Bicycling
- Football (hamstring syndrome)
- Yoga
Superficial peroneal nerve
- Running
Interdigital nerves of foot
- Running
Tibial nerve
- At tarsal tunnel
  - Hockey
  - Hiking
  - Running
Sural nerve
- Ballet dancing
- Running
Lateral femoral cutaneous nerve
- Gymnastics
- Running
- Scuba diving
Posterior cutaneous nerve of the thigh
- Bicycling
Superficial peroneal nerve
- Rollerskating
- Running
Saphenous nerve
- Surfing
- Running
Dorsal cutaneous nerve of foot
- Ballet dancing
Lumbar radiculopathy
- Football
Morton’s neuroma of plantar nerve
- Ballet dancing
- Judo, karate, and kickboxing
- Running
Plantar nerves of feet
- Running
Calcaneal neuropathy
- Running
Rhabdomyolysis
- Bodybuilding/weightlifting
- Running

Injuries of the PNS attributable to sport organized by anatomic location

Archery

The use of an archery bow can lead to compression of the digital nerves. Compression of the median nerve at the wrist and at the pronator teres intersection can also occur with repeated drawing of the bow. Finally, an isolated long thoracic nerve palsy has also occurred in an archer. The action of repeated drawing of the bow leading to relative hypertrophy of shoulder and periscapular muscles may play a role in compression of these nerves. Archery safety may be improved with switching to the use of a light-weight bow, proper forearm flexor muscles conditioning, and modifications in the procedure of drawing the bowstring.

Arm wrestling

The action of arm wrestling can lead to humeral shaft fractures, particularly during the end of a match, when full force is being exerted to win the match or to change momentum. In 23% of these fractures in arm wrestlers, concurrent radial nerve palsy occurs.