BURNERS or STINGERS
"A Brachial Plexus Injury"

WHAT IS A STINGER OR BURNER?:    Stingers, or burners, are injuries that occur commonly in collision or contact sports such as football, ice hockey, and wrestling.  The athlete usually complains of "burning" pain in the shoulder with both shoulder and arm weakness.   the pain often radiates or "seems to move" toard the hand. The injury usually occurs following a hard block or tackle.  The sensation of not being able to move teh arm or pain in the trapezius muscle is typical.  Up to 50% of coolegiate football players may experience this injury at some time in their playing career.

The injury occurs when a network of nerves, called the brachial plexus, is stretched from lateral flexion (bent to the side) or hyperextension (bent backwards) of the neck.  The brachial plexus carries the nerves that allow movement and sensation to the upper extremity.  Normally, the symptoms of pain and weakness last only several weeks and rarely can be permanent if the nerves are disrupted.  These injuries are graded I, II, III.  In a grade I injury, the nerves are "stunned" and pain resolves and muscle strength returns quickly.   Grade II injuries have actual nerve damage with symptoms lasting up to several weeks or months.  In grade III injuries, this nerve damage leads to deficits in strength and sensation of at least 1 year.

The muscles usually affected with a burner or stinger injury are the deltoid, biceps, supraspinatus and infraspinatus.  Full recovery may take weeks although return to activity may resume when pain has subsided and muscle strength has recovered.

WHAT YOUR TRAINER OR TEAM PHYSICIAN SHOULD LOOK FOR:    The most important thing is to rule out a more serious injury, such as a spinal cord injury or problems with the cervical spine.  If your physician or trainer finds neck pain, loss of consciousness, or if both arms are involved, he or she will remove you from participation until a full work-up including x-rays can be performed.  MRI or electromyography may be needed in severe cases.   The team doctor or trainer will check to see if you can raise and rotate your arm and bend your elbow as required in throwing a football.

TREATMENT: Treatment for a typical burner involves rest and allowing time for the nerves to recover.  Ice can be applied for trapezius muscle pain.  Tylenol, ibuprofen or other NSAID (non-steroidal anti-inflammatory drug) medications are often used for the first few hours or days.   You may be given specific exercises to strengthen certain muscles.

RETURN TO ACTION:    You can return to contact situations when you are pain free and muscle strength is adequate.  Your coach or trainer should have your helmet and shoulder pads rechecked for proper fit.  You should be fitted for a neck roll to help prevent the stretching that led to the original injury.  Be aware that neck rolls are too small to provide real protection.

IMPORTANT:     Any player who has suffered a stinger or burner is at increased risk for repeat injury and for a more severe nerve injury. 

Article by 
Matthew A. Murdoch, MD
Sports Medicine Plus
August 1999

References:   

Garrick, JG and DR Webb, Sports Injuries: diagnosis and management, 2nd edition, Saunders, 1999.

McMillan, JA, et al, Oske's Pediatrics, 3rd edition, Lippincott, Williams, and Wilkins, 1999.

Hoppenfeld, Stanley, Physical Examination of the Spine and Extremities, Appleton asd Lange, 1976.

Safran, MR et al, Manual of Sports Medicine, Lippincott-Raven, 1998.