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Key Features

Essentials of Diagnosis

  • Symptoms appear on the same side as an injury to the neck and shoulder.

  • Burning pain or numbness in the shoulder and arm.

  • Weakness may be present.

General Considerations

  • Burners or stingers are common injuries in contact sports, especially football

  • The two terms are used interchangeably to describe transient unilateral pain and paresthesias in the upper extremity

  • These cervical radiculopathies or brachial plexopathies typically occur when the head is laterally bent and the shoulder depressed, causing

    • Exacerbation of a degenerative cervical disk or stenosis

    • A compressive injury to a cervical nerve root on the symptomatic upper extremity

    • Traction injury to the brachial plexus of the ipsilateral shoulder

Clinical Findings

  • Immediate burning pain and paresthesias down one arm generally lasting only minutes

  • Unilateral weakness in the muscles of the upper trunk

    • Tends to resolve quickly

    • Can persist for weeks


  • The most important part of the workup is a thorough neurologic assessment to differentiate this injury from a more serious brain or cervical spine injury. The key distinguishing feature of the stinger is its unilateral nature.

  • If symptoms persist or include bilateral complaints, headache, change in mental status, or severe neck pain, a diagnostic evaluation should include

    • A careful neurological examination

    • Possibly cervical spine radiographs, including flexion/extension views, magnetic resonance imaging scans, and electromyography


  • Consists of removal from play and observation

  • The athlete can return to play once symptoms have resolved, neck and shoulder range of motion is pain-free, reflexes and strength are normal, and the Spurling test is negative

  • The Spurling test is performed by having the neck extended, rotated, and flexed to the ipsilateral shoulder while applying an axial load

  • Restriction of same day return to play should be considered in athletes with a history of multiple stingers, particularly if sustained in the same season



  • Wearing well-fitting protective gear

  • Proper blocking and tackling techniques

  • Maintaining neck and shoulder strength


  • Long-term complications are possible, including permanent neurologic injury or repeated occurrence of stingers, which would necessitate further workup and possible lifetime exclusion from contact or collision sports


Cantu  RC, Li  YM, Abdulhamid  M, Chin  LS: Return to play after cervical spine injury in sports. Curr Sports Med Rep 2013;12:14–17
[PubMed: 23314078]
Standaert  CJ, Herring  SA: Expert opinion and controversies in musculoskeletal and sports medicine: stingers. Arch Phys Med Rehabil 2009;90:402–406
[PubMed: 19254603]

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