Stingers & Burners
A burner or stinger is an extremely painful injury to the nerve supply in the neck or shoulder, commonly sustained in contact sports.
Nerves originate in the spinal canal. Nerve fibers travel in bundles, with smaller bundles branching off main bundles to innervate more distant parts of the body. The nerves responsible for transmitting information to and from the arm leave the spinal canal between the vertebrae (spinal bones) in the neck. They group together into a network called the brachial plexus that branches out under the collarbone before travelling into the shoulder, and then down the arm and into the hand and fingers.
A burner or stinger injury can happen in two ways. If, as often happens during contact or collision sports, a tackle or fall results in the head of the athlete being forced down and sideways, the neck is bent and the nerves running from the spinal canal to the shoulder can be stretched. The other mechanism is that the head is forced backwards and sideways, which compresses the nerves on that side. Whether by stretching or compression, damage to the brachial nerve plexus produces the electric shock-like symptoms for which this injury is named.
Nearly two-thirds of college football players suffer a burner or stinger during their time playing at college. It is an injury primarily associated with contact sports, particularly football, although it can be caused by any situation where the brachial plexus is damaged.
It has been found that people with naturally occurring narrower spinal canals, a condition called spinal stenosis, are at greater risk for sustaining a burner or stinger.
The injury is named for the main symptoms that it produces. These symptoms can last for a varying length of time: anywhere from a few seconds to, rarely, several days or longer.
Symptoms are confined to one arm. Commonly experienced symptoms are:
- Immediate and intensely painful burning or stinging sensation, similar to an electric shock, that travels from the neck down the arm to the fingers.
- Weakness and numbness in the arm immediately after the injury that may or may not be long lasting. The injury typically affects the ability to bend the elbow, grip or abduct the arm (lift it away from the body).
- Sensation of heat
The athletic coach, team doctor or physical therapist is likely to be the first person to assess the condition of the athlete after sustaining an injury of this kind. Neck, nerve function, arm muscle strength, and reflexes will be examined and tested. More serious spinal injuries need to be ruled out. In some cases, a burner or stinger injury is accompanied by a dislocation, fracture, ligament damage, or spinal cord injury, so evaluation of the condition will be careful and thorough.
It is extremely important for the athlete to report having had a stinger or burner, even if the symptoms rapidly disappeared. Failure to do so can result in permanent nerve damage.
Imaging tests such as X-ray, CT (computerized tomography) and MRI (magnetic resonance imaging), or nerve conduction tests, are usually not needed, unless other conditions are suspected or symptoms are persistent or recurrent.
The primary treatment for a burner or stinger injury is rest, in order to allow the damaged nerves to heal. Because this is almost always a sporting injury, the athlete must refrain from sporting activity until all feeling and strength has returned to the neck, shoulder, and arm; the range of motion of the neck, shoulder, and arm is normal; and reflexes are regular. If the injury was mild, the athlete may be able to return to sports after a few moments. In other cases he or she may have to wait a few hours, a few days, or even longer.
Along with rest, the neck can be regularly iced, for as long as is comfortable, several times a day, for the first 48 hours. After that time, heat should be applied to the neck and shoulder in order to promote greater blood flow to the injured area.
NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve) or aspirin can be taken, according to directions, to relieve swelling and pain. If there is muscle spasm present, a muscle relaxant may be prescribed.
It might be helpful to temporarily wear a cervical collar, to prevent the brachial plexus nerves being further damaged. Cervical traction (gentle stretching), administered by a physical therapist, can relieve pressure on the nerve root.
To prevent recurrent injury, special shoulder pads or a neck roll should be worn during sports. Subsequent burner and stinger injuries tend to become more severe each time and can result in permanent nerve damage.
Physical therapy should include exercises to strengthen the neck and shoulder muscles, and to promote full range of motion.
Follow-up evaluations should happen regularly until the athlete has completely recovered.
If symptoms do not disappear with time and the treatments described above, the doctor may administer a corticosteroid injection into the damaged nerve root area. This is known as a nerve root block and can significantly reduce inflammation of the nerve.
Surgery is rarely necessary. It might be performed if a herniated (bulging) vertebral disc or a bone spur is compressing the nerve root. If required, the surgeon would discuss the available options with the patient, taking into consideration all the factors relating to the case. Following surgery, rehabilitation would consist of physical therapy to restore range of motion and strength, and correct any postural abnormalities that might contribute to further injury.
While performing these exercises, do not move the neck.
1: Sitting, place the fingers of both hands on the forehead. Press the fingers against the head for a count of 5. Repeat 5-10 times.
2: Sitting, place both hands on the back of the head. Press the hands against the head for a count of 5. Repeat 5-10 times.
3: Sitting, place one hand against the side of the head, above the ear. Press the hand against the head for a count of 5. Repeat 5-10 times. Repeat exercise with the other hand.
Repeat the above exercises, but in this sequence bend the neck downwards during exercise 1, backwards during exercise 2, and to each side, moving the ear towards the shoulder, during exercise 3.