By Dr. Michael Cushing, M.D.
Injury to the nerves of the neck and shoulders that cause a burning or stinging feeling down the arm are called burners or stingers. This injury is most commonly seen in football players, but is also seen in wrestlers, cheerleaders, gymnasts, and other sports. More than 50% of college football players report having at least one stinger in their careers.
A stinger is a nerve injury. Nerves to the arm originate from the neck (cervical spine). As the nerves leave the neck they weave together and then branch again forming an intricate bundle of nerves known as the Brachial Plexus. This plexus passes beneath the clavicle to reach the arm.
The injury occurs when the athlete makes a hard hit with the shoulder in tackling or blocking. There is a direct blow to the top of the shoulder and the neck bends in the opposite direction. This causes a stretch or compression injury to the nerves leading to an intense electrical pain. After the nerve injury, the nerves motor fibers that allow movement do not function well. This is seen as weakness in the arm.
Symptoms – Symptoms include a burning or electrical shock from the neck to the fingers. Often described as a “lightning bolt” sensation. Arm numbness and weakness are common. Pain typically lasts a few minutes. Depending on the severity of the injury, weakness can last a few minutes, to a few hours, days, or weeks. Occasionally, permanent nerve damage can occur. Players are often seen running off the field with the limp arm hanging by their side.
Evaluation and Return to play – Evaluation by a physical therapist, athletic trainer or team physician occurs immediately on the sidelines. An examination of the cervical spine, strength and reflexes in the affected extremity is performed. Burners involve only one extremity, while spinal cord injuries commonly involve both extremities. If the athlete has any neck or pain or numbness in both arms, cervical spine precautions should be taken.
Treatment – Treatment after the game includes re-evaluation by a physician in the office. No return to play until they are pain free, have normal sensation and strength, and have full range of motion of neck and shoulder. Often patients will be started in physical therapy for cervical and shoulder strengthening, as well as neurodynamics to help with nerve recovery.
Recurrent stingers tend to be more serious and can damage nerves permanently. Players will tend not to tell the trainer of an initial stinger for fear of being held out of play. This will often lead to a more serious and longer lasting injury. It is important for each athlete to immediately notify their trainer or team physician after the first symptoms occur. Players with recurrent stingers need further evaluation and work up by an orthopedic surgeon. Xrays, MRI or CT scan can evaluate the size of the spinal canal, as players with recurrent stingers can have narrowing of their spinal canal.
Prevention – The most important part of sports injury is prevention. For stingers, this includes proper tackling technique, shoulder pads, and neck roll that fit properly and are in good condition, and pre-season conditioning to develop full range of motion and strength in the neck.