What is a stinger or burner?
A stinger or burner is an intensely painful nerve injury. The nerves that give feeling to the arms and hands originate from the cervical (neck) spinal cord. As these nerves leave the neck, they form the brachial plexus (see Fig. 1). They weave together then branch as they pass under the clavicle (collar bone) on the way to the shoulder.
Nerve injury often happens when the athlete makes a hard hit using his shoulder. The direct blow to the top of the shoulder drives it down and causes the neck to bend toward the opposite side. This motion severely stretches or compresses the nerves and triggers an intense discharge of electricity. For a few seconds, the electricity shoots down the nerves to the tip of the fingers.
After this intense electrical discharge, the nerves' motor fibers that allow movement in the arm do not function well. The dysfunction is evident by weakness in the arm. The weakness often involves the muscles that allow the athlete to lift the arm away from the body, to bend the elbow, and to grip. Symptoms also include sensations of tingling and of burning or stinging pain in the arm and hand. The extent of the damage varies considerably. The pain usually lasts only a few minutes, but the weakness can last weeks, months, or years. Rarely, the injury may cause permanent damage.
Nerve roots exit the spinal canal of the neck and come together to form cords of nerves. These nerves ultimately provide sensation and motor innervation to the muscles of the arm.
The nerve roots are named for the level at which they exit the spinal canal. For example, the term C5 refers to cervical nerve root 5, which exits the spinal cord at the 5th cervical spinal body.
As the nerve roots move away from the spinal canal, they join to form larger bundles or cords. In the upper extremity this is called the brachial plexus. All of the nerve supply to the arms runs through this plexus. This is also a potential site of injury that can cause a burner or stinger.
How do we prevent these injuries?
Preventing recurrent stingers is important. Subsequent injuries tend to be increasingly severe and can damage the nerve permanently. Athletes, coaches, officials, athletic trainers, and parents need to ensure that athletes follow these three minimal guidelines. First, use proper technique in tackling as mandated by the 1979 football rule outlawing spearing or head tackling. Second, make sure that the shoulder pads and neck roll, if used, fit properly and are in good condition. Third, before the season begins, participate in an exercise program to develop full range of motion and protective strength of the neck and shoulder muscles.
Preventing Burners / Stingers
- Use protective gear (a collar for football) and proper sports technique
- Avoid awkward positions of the head an neck
- Stretch your neck muscles prior to activity
- Strengthen your neck, back and shoulder muscles
- Return to activity slowly after sustaining a burner or stinger
- See a physician if you experience recurrent burners and stingers
Causes of Burners / Stingers
These are common football injuries, but many people experience the sensation during car accidents, or by simply turning the head quickly.
Burners and stingers are a common injury in contact sports. Athletes who engage in contact sports are more likely to suffer this injury. In fact, up to 70 percent of all college football players report having experienced a burner or stinger during their 4-year careers.
Tackling or blocking in football is the most common athletic activity causing a burner or stinger. Football defensive players and lineman therefore frequently suffer this injury. Another possible mechanism is a fall onto the head, such as in a wrestling takedown or a football tackle.
In addition to the type of sport, another risk factor may be the size of the spinal canal. It has been suggested that athletes with recurrent stingers or burners may have a smaller spinal canal than players who do not suffer recurrent injury. This is a condition called cervical, or spinal, stenosis.
The injury is to the nerve supply of the upper limb, either at the neck or shoulder. In most cases, the injuries are temporary and symptoms resolve quickly.
- A burning or electric shock sensation is often felt.
- The arm may feel numb immediately following the injury, and weakness is common.
- The symptoms most commonly occur in one arm only.
- Symptoms usually last seconds to minutes, but in 5 percent to 10 percent of cases, they can last hours, days, or even longer.
An orthopaedic surgeon makes the diagnosis based upon the history of injury and the symptoms. X-rays, magnetic resonance imaging (MRI), and other nerve studies are not usually needed.
More extensive examination is needed if there are any of the following symptoms :
- Weakness lasting more than several days
- Neck pain
- Symptoms in both arms
- History of recurrent stingers/burners
Usually the pain subsides in a minute without any long-term problems. See a physician if the injury that caused the burnier was severe 9such as an impact) to rule out a serious condition such as a slipped disk or spinal cord problem. Seek immediate medical attention if both of your arms are affected, ou received a blow to the head.
If this occurs during sports, you need to be sure all your symptoms resolve entirely before you return to the game. If you return too quickly, the risk of re-injury is high.
Treatment begins by removing the athlete from further injury. Athletes are not allowed to return to sports activity until their symptoms are completely gone. This can take a few minutes or several days. Athletes should never be allowed to return to sports if they have weakness or neck pain.
Although the injury gets better with time, the athlete may need to work with a trainer or therapist to regain strength and motion if the symptoms last for several days. Top of page
Surgery is not a treatment option for burners or stingers. Management remains conservative (nonsurgical). Patients are followed through the athletic season until recovery is complete.
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