A stinger or burner is a bruise to a special highway of nerves in the neck called the brachial plexus.
Several years ago, I was the doctor on the sidelines for a high school football game. The running back had a big collision with a defensive safety. He was slow to get up and came off the sidelines with radiating left arm and neck pain. He sustained a “stinger” or burner to his neck and brachial plexus. He recovered completely from the stinger and went on to finish the season. Many people ask me what is a stinger or burner. Here are 5 key points to understanding a stretch or bruise to the brachial plexus.
WHAT IS THE BRACHIAL PLEXUS?
The brachial plexus is a complex highway of nerves that originate from the cervical spine. These nerves are from C5-T1. These nerves give sensation and strength to the muscles of the arm. They travel from the neck down the arm to make up the major named nerves of the arm, chest and shoulder.
WHAT IS A STINGER OR BURNER?
This is when the brachial plexus or cervical nerve root sustains a stretch or pinch during a collision. The most well-known cause of stingers is in football although other conditions such as a traumatic fall onto the neck can occur. It is reported that up to 60% of collegiate football players have had a stinger. Most of the time a stinger or burner is temporary and resolves in seconds or minutes. Approximately 10% can have a stinger or burner last longer and requires a workup.
WHAT ELSE IS CONSIDERED WITH A STINGER OR BURNER?
The nerves in the brachial plexus originates from the spinal cord. It is important to consider conditions where there is cervical spinal stenosis. This is when the space in the spinal cord is tight and any significant stretch can lead to symptoms. In football, there can be a transient spinal cord injury that involves both arms and possibly the legs. Finally fractures or concussions can also mimic a stinger.
HOW DO YOU WORK UP A STINGER OR BURNER?
The vast majority of symptoms resolve quickly and usually the history points to the diagnosis. Typically x-rays or an MRI is not necessary. If however a patient has prolonged weakness, pain or recurrent stingers, then x-rays or an MRI may be appropriate. The MRI is used to take a deeper look into the spinal canal and look for congenital stenosis or a herniated disc. If a fracture is suspected, I will order a CT scan to look at the bony anatomy.
WHAT IS THE RECOMMENDATION IN RETURN TO PLAY?
If an athlete has a stinger with persistent symptoms, then a work up with a spinal specialist is in order. In addition, 2 stingers is also an indication for an evaluation in the office. Most experts recommend that 3 stingers in one season is an indication that the athlete should not return to play. If you or someone you know has had a stinger and does not recover completely, make sure they are worked up. The time invested will be well worth it and hopefully prevent further issues down the road.
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