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The Neurological Phenomenon of Stinger or Burner Injuries


WE TEND TO LOOK FOR signs and symptoms of a concussion after a big hit in a football game. But as a sports neurologist, concussion is only one of the injuries I'm looking for as players pick themselves up and return to the huddle or sideline. Body language can tell you a lot. How players move, whether or not they're fluid and symmetric in their arm-swing and obvious or subtle evidence of a "dead arm" can indicate a neurological injury to the nerves. Unfortunately, just like with concussion, players often try to hide these injuries. And even though the vast majority of such injuries will resolve spontaneously within minutes, they must be correctly identified and appropriately managed to avoid severe and permanent neurological damage.

Suffered most often by athletes who engage in high-contact sports that involve head or neck impact, such as American football and rugby, these injuries are popularly named for the sensation they create when a nerve is pinched or stretched. While American football edges toward the top of the list for the types of athletes who sustain stinger injuries, they are experienced by a wide range of athletes who engage in a variety of sports including wrestling, hockey, gymnastics, horseback riding, lacrosse, rugby and even soccer. These injuries often happen when a player makes a particularly forceful impact with the shoulder that results in the head and neck driving sideways or backward. Beyond an increased risk among athletes who play a particular sport, there is also an increased risk of these injuries in people who were born with stenosis (narrowing) of spaces within the spinal canal – possibly placing them at increased risk of permanent or even catastrophic injury.

When an athlete experiences a stinger or burner, at the moment of impact a bundle of nerves between the neck and shoulder area called the brachial plexus is injured. The most immediate symptom is often a stinging or burning electrical sensation and pain that is felt in the arm. This pain can also be accompanied by arm weakness or numbness that can radiate all the way down to the hand. The pain itself is typically short-lived (lasting seconds) but can last for hours or days in some people who are severely affected. Depending on the severity of the injury, and in rare cases, it can also cause permanent damage, especially if the injury occurs repeatedly.

Because the symptoms of a stinger/burner are often self-limiting in nature, meaning they tend to "go away" on their own, athletes can sometimes think they're no big deal and shake them off without telling a coach, trainer or physician. As one can imagine, that's a mistake. Clinical evidence has shown that once someone has sustained a stinger/burner injury, he or she is more likely to suffer another – which increases the risk of longer-lasting or permanent damage. It's also important to keep in mind that these types of injury always warrant evaluation by a trained and experienced health care provider.

As far as treatment goes, this again depends on a thorough evaluation of the individual to assess the extent of the injury. Sometimes, a bit of rest is all that's required. In other cases, ice and anti-inflammatory or other medications may be recommended. Moreover, in cases where there is a prolonged duration of symptoms, diagnostic imaging, electrical testing, physical therapy or other rehabilitative work might be indicated. Ultimately, these recommendations need to be made by a medical expert.

Athletes who have sustained burner or stinger injuries should not return to their sport (including conditioning or practice) until the pain is completely gone, complete range-of-motion and muscle strength have returned and there are no other residual symptoms, such as tingling, numbness or weakness. These may sound like excessive recommendations for an injury that seems to be so short-lived for most people, but I can tell you from experience that following them puts athletes on a much better path to success than shaking them off. Similar to the experience of concussions, we know that neurological injuries, no matter how seemingly mild or benign, should be handled differently than musculoskeletal injuries. The old sayings "you can play hurt, but you can't play injured" and "play through the pain" do not apply to the nervous system.