Burners and Stingers: What are they exactly?
By Doug Haltom, M.D.
Burners and stingers, interchangeable terms, are perhaps the most common injury in football. The true incidence is uncertain because they occur so commonly and are so familiar to athletes and coaches that most do not seek medical attention. Up to 65% of collegiate football players report having had a burner or stinger during their four-year college career.
Stingers result from injury to the brachial plexus, an arrangement of nerve fibers that originate from the cervical spine, course through the neck, the armpit and into the arm. (See picture above right.) It supplies motor function and sensation to the upper extremities. The most common mechanism in younger athletes is one of traction and often happens during blocking or tackling. The shoulder is often driven downward, with the head and neck bending in the opposite direction.
Athletes usually complain of temporary numbness, weakness and/or electrical pain that shoots down the arm to the hand.
Complaints almost always involve just one arm, and athletes rarely complain of neck pain. Symptoms typically last seconds to minutes; however, in 5 to 10% of cases, the symptoms can last hours, days or even weeks.
Because of the mechanism, the upper portion of the brachial plexus is most often affected. This means that the deltoid (large shoulder muscle), biceps and rotator cuff muscles are often affected. The numbness and tingling is often along the lateral or outside portion of the arm.
Symptoms are usually self-limited and mild. Return to contact is predicated by pain-free, full range of motion of the neck and shoulder and a normal neurological exam. This includes full strength of the involved muscles of that extremity. Because most athletes have resolution of symptoms and a normal exam within minutes, most return to play the same game.
The key to treating stingers is to prevent recurrence. Resolving the symptoms before returning to contact or play is an important step not only in preventing recurrence, but in decreasing the duration of symptoms. Other steps include proper tackling techniques and wearing shoulder pads that fit appropriately. Protective collars that limit neck extension may also help prevent recurrence.
The most important consideration, however, is to rule out underlying factors that may predispose the athlete to a more serious injury. This is especially true in recurrent stingers and in the athlete who has prolonged symptoms.
Multiple studies have shown a high correlation between recurrent stingers and developmentally narrowed spinal canals. So the issue is not necessarily the treatment of first-time stingers, but in ensuring that the athlete with recurrent ones is not at risk for a more serious injury.