Overview
Open injuries involving the supraclavicular nerve, often sustained in high-impact sports such as Gaelic football (GAA) and rugby, present unique clinical challenges due to their location and potential for significant functional impairment. These injuries are frequently associated with contact sports characterized by physical demands akin to those seen in elite female team sports like soccer, rugby sevens, and field hockey [12–14] [PMID:40758739]. The supraclavicular nerve, a branch of the brachial plexus, innervates muscles in the shoulder and upper arm, making injuries to this area particularly concerning due to potential deficits in shoulder function and pain syndromes. Epidemiological studies highlight that male student-athletes exhibit a higher injury rate compared to females (21.6 vs 11.3 injuries/1000 h), with lower extremity injuries predominating (68.8%), particularly ankle sprains, which can lead to substantial time loss (20.6-280.2 days absent/1000 h) [PMID:34144388]. Advances in imaging modalities have improved the identification of injury patterns, underscoring the necessity for a multidisciplinary approach to management [PMID:32987421]. Despite these advancements, gaps in medical support and injury prevention strategies persist, particularly in school settings where formal injury monitoring, physiotherapy availability, and access to medical doctors are inconsistently implemented [PMID:32169791].
Epidemiology
The epidemiology of open injuries involving the supraclavicular nerve is closely tied to the physical demands and training dynamics of high-impact sports. Studies indicate that sports like Gaelic football and rugby exhibit injury rates comparable to those in elite female team sports, reflecting the rigorous physical requirements of these activities [12–14] [PMID:40758739]. Bouzigues et al. ([PMID:38917033]) elucidated a significant correlation (r2 = 0.26) between fluctuating training loads and injury occurrence, emphasizing the importance of monitoring and managing training intensity to mitigate injury risk. Notably, most injuries (87.5%) occur during practice rather than competition, suggesting that training environments may require enhanced safety protocols [PMID:31596752]. The injury rate, while relatively low at 2.43 injuries per 1000 athlete exposures, predominantly involves musculoskeletal injuries (88%), with lower extremity injuries being most frequent [PMID:31596752]. Wrestling, another high-impact sport, reports a higher injury incidence (42.3 injuries per 100 wrestlers per year), with wrestling injuries accounting for significant hospitalizations and surgical interventions [PMID:22764448]. In pediatric athletes, tennis injuries often stem from repetitive microtrauma, affecting the shoulder, back, and knee, indicating the need for tailored preventive strategies [PMID:16247255]. Play-wrestling, particularly among younger children, also poses risks, with fractures of the distal radius being a common injury type [PMID:15869066]. These findings underscore the diverse injury patterns across different sports and age groups, necessitating sport-specific and age-appropriate injury prevention and management strategies.
Clinical Presentation
Clinical presentation of supraclavicular nerve injuries can vary widely depending on the severity and specific mechanisms of injury. Elite athletes often underreport injuries due to concerns about performance and team dynamics, which can delay diagnosis and treatment 8 [PMID:40758739]. Bouzigues et al. ([PMID:38917033]) further highlight that physiological factors, such as intense jumping activities, significantly correlate with injury risk (r2 = 0.94), indicating that clinicians should consider training load metrics when assessing athletes. Common injuries include hamstring strains and knee sprains, which can result in substantial time loss (e.g., 84.8 days absent/1000 h for knee sprains in female Gaelic footballers) [PMID:34144388]. Both male and female athletes experience similar injury rates, with a majority (75%) recovering within two weeks, though individual recovery times can vary based on injury severity and promptness of intervention [PMID:31596752]. In wrestling, hand and wrist injuries are most frequent, followed by knee injuries, reflecting the nature of grappling and impact sports [PMID:22764448]. Specific injuries like fractures of the distal radius, common in play-wrestling among children, often require careful management to prevent long-term complications [PMID:15869066]. Clinicians must be vigilant in recognizing subtle signs of nerve injury, such as pain, weakness, and sensory deficits in the shoulder and upper arm, to ensure timely and effective management.
Diagnosis
Diagnosing injuries involving the supraclavicular nerve requires a comprehensive approach that integrates clinical assessment with advanced imaging techniques. Musculoskeletal radiologists play a pivotal role in accurately identifying and characterizing these injuries through modalities such as MRI and ultrasound [PMID:32987421]. Clinical examination should focus on assessing motor function, sensory deficits, and pain patterns specific to the supraclavicular nerve distribution. Electromyography (EMG) and nerve conduction studies can further elucidate nerve damage and help differentiate between neuropraxia, axonotmesis, and neurotmesis [PMID:32987421]. Given the complexity of these injuries, a multidisciplinary team including orthopedic surgeons, physiatrists, and neurologists is often necessary to provide a thorough evaluation and accurate diagnosis. Early imaging and diagnostic workup are crucial to guide appropriate treatment strategies and prevent chronic complications.
Differential Diagnosis
Differentiating supraclavicular nerve injuries from other shoulder and upper arm pathologies is essential for effective management. Coaches and medical staff often underestimate the frequency of injury underreporting, leading to potential misdiagnosis or delayed treatment 20 [PMID:40758739]. Common differential diagnoses include rotator cuff injuries, shoulder dislocations, and cervical spine issues, which can present with similar symptoms such as pain, weakness, and limited range of motion. Clinicians must consider the athlete's training history, mechanism of injury, and specific clinical findings to rule out these conditions. For instance, a history of direct trauma to the shoulder or neck can help distinguish between traumatic injuries and overuse syndromes. Additionally, imaging studies like MRI can provide critical insights into soft tissue injuries and rule out structural abnormalities that might mimic nerve injuries. Ensuring comprehensive pre-participation physical examinations can also aid in identifying underlying conditions that predispose athletes to these injuries [PMID:16247255].
Management
Effective management of supraclavicular nerve injuries necessitates a multifaceted approach involving immediate medical intervention, rehabilitation, and preventive strategies. Open communication and frequent interactions with athletic trainers (ATs), physiotherapists, and medical personnel are crucial for encouraging timely injury reporting and initiating appropriate treatment protocols 81821 [PMID:40758739]. Bouzigues et al. ([PMID:38917033]) propose quantifying training loads using metrics like weighted jumping intensities to identify critical thresholds above which injury risk escalates, informing tailored training schedules to mitigate future occurrences. For acute injuries, conservative management often suffices, including immobilization, pain control, and early mobilization exercises tailored to the athlete's recovery phase [PMID:31596752]. In cases requiring surgical intervention, intraarticular injections of local anesthetics combined with low-dose opioids (e.g., 0.25% bupivacaine with 1 mg morphine) can effectively manage postoperative pain with reduced opioid utilization [PMID:11097669]. Rehabilitation programs should focus on restoring strength, flexibility, and functional capacity, often incorporating manual therapy, therapeutic exercises, and modalities like ultrasound or electrical stimulation. Preventive strategies, such as structured warm-up routines, targeted strengthening exercises for the shoulder and upper arm, and regular monitoring of training loads, are essential to reduce injury recurrence, particularly in high-risk populations like male athletes and those with lower extremity vulnerabilities [PMID:34144388]. Addressing gaps in medical support, such as ensuring access to physiotherapy and medical doctors in school settings, is also critical for comprehensive athlete care [PMID:32169791].
Complications
Supraclavicular nerve injuries can lead to various complications beyond the immediate functional deficits. Skin infections and upper respiratory tract infections (URTI) are notable secondary issues that can prolong recovery and disrupt training schedules, particularly in contact sports like wrestling where close physical contact is frequent [PMID:22764448]. In pediatric populations, complications such as delayed healing or malunion in fractures, especially of the distal radius, may necessitate surgical intervention, including general anesthesia for reduction procedures [PMID:15869066]. While intraarticular morphine administration has shown efficacy in pain management post-surgery without increased complications, vigilance is required to monitor for potential side effects and ensure proper pain control strategies [PMID:11097669]. Long-term complications may include chronic pain syndromes, muscle atrophy, and persistent functional limitations, underscoring the importance of thorough follow-up care and rehabilitation to optimize recovery outcomes.
Special Populations
Special attention is warranted for specific populations, such as student-athletes, who often face unique challenges in injury prevention and management. Despite formal injury monitoring being implemented in 86% of schools, gaps persist in access to essential medical resources. Only 28% of schools reported physiotherapy availability, and just 14% had medical doctors on hand, highlighting significant disparities in medical support [PMID:32169791]. This disparity can delay diagnosis and treatment, particularly for injuries requiring specialized care. Additionally, the prevalence of informal injury prevention measures (only 66% of schools implementing structured warm-ups) underscores the need for standardized protocols across educational institutions. Ensuring comprehensive pre-participation physical examinations is crucial, as only two-thirds of wrestlers had undergone such evaluations, indicating a need for improved screening practices to identify underlying risk factors early [PMID:22764448]. Tailored interventions addressing these gaps can significantly enhance the overall health and performance of student-athletes.
Key Recommendations
These recommendations aim to create a safer sporting environment, optimize athlete recovery, and enhance overall performance through proactive and evidence-based practices.
References
1 Gilhooly M, Cahalan R, O'Sullivan K, Norton C. Injury reporting in elite ladies Gaelic football and camogie: Perspectives of athlete support personnel. PloS one 2025. link 2 Bouzigues T, Maurelli O, Imbach F, Prioux J, Candau R. A New Training Load Quantification Method at Supramaximal Intensity and Its Application in Injuries Among Members of an International Volleyball Team. Journal of strength and conditioning research 2024. link 3 Teahan C, O'Connor S, Whyte EF. Injuries in Irish male and female collegiate athletes. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 2021. link 4 Sullivan CJ, Kavanagh EC, Eustace SJ. Gaelic Sport Injuries. Seminars in musculoskeletal radiology 2020. link 5 Leahy TM, Kenny IC, Campbell MJ, Warrington GD, Cahalan R, Harrison AJ et al.. Injury surveillance and prevention practices across Rugby schools in Ireland. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 2020. link 6 Walrod B, Turner W, Hartz C. A Prospective Cohort Study of Collegiate Fencing Injuries. Current sports medicine reports 2019. link 7 Kordi R, Ziaee V, Rostami M, Wallace WA. Sports injuries and health problems among wrestlers in Tehran. JPMA. The Journal of the Pakistan Medical Association 2012. link 8 Kibler WB, Safran M. Tennis injuries. Medicine and sport science 2005. link 9 McCarthy T, Crushell E, Synnott K, Kiely P, McCormack D. Play-wrestlers and their injuries. Irish medical journal 2005. link 10 Tetzlaff JE, Brems J, Dilger J. Intraarticular morphine and bupivacaine reduces postoperative pain after rotator cuff repair. Regional anesthesia and pain medicine 2000. link
10 papers cited of 11 indexed.