Burners or Stingers

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

Diagnosis

• 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

Treatment

• 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

Outcome

Prevention

• Wearing well-fitting protective gear

• Proper blocking and tackling techniques

• Maintaining neck and shoulder strength

Complications

• 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

References