What is it?
Stingers, also known as burners, are common injuries in contact sports, such as American football and rugby.  These injuries can also be seen in wrestling, hockey, basketball, and boxing.  A stinger results from either direct contact or stretch to some of the nerves as they exit the neck and travel down the affected arm; this is why the injury can sometimes be felt all the way down the upper extremity into the fingers.

Symptoms

• Symptoms are felt in only one arm, not both
• Pain, sometimes very intense and described as burning
• Weakness
• Numbness
• The athlete may be seen carrying the injured arm with his or her unaffected arm, as he or she leaves the playing field or court. 

Sports Medicine Evaluation and Treatment
A sports medicine physician will ask the athlete questions about the injury and perform a full neurologic examination, testing sensation, strength, and reflexes. Movement of the neck and shoulders will be evaluated as well.  The symptoms are only one-sided in a stinger, and symptoms affecting both arms raise concern for a potentially more serious spinal cord injury. 

If the evaluation occurs at the time of injury, and the symptoms are concerning, the sports medicine physician may protect the athlete by immobilizing his or her neck. This may be done by placing him/her on a spine board, and transporting him/her to the hospital for further evaluation. 

For a stinger, testing for range of motion and strength will be repeated at regular intervals, with anticipation that the athlete will improve over time. 

For symptoms lasting longer than expected, the athlete may be referred for further testing, including an x-ray or MRI. 

Treatment typically involves protecting the affected arm, sometimes with a sling for comfort.  The athlete may also need medications for pain, and may be referred to a structured rehabilitation program guided by an athletic trainer or physical therapist to help regain full function.

Injury Prevention
The best prevention is using proper technique, such as tackling in football and rugby.  Strength and balance exercises designed to prepare an athlete for competition, with particular focus on the neck and core, may also help to prevent injury.  The athlete may also try additional protective padding, even if already wearing shoulder pads.

Return to Play
The athlete should regain full range of motion and strength in the neck and affected arm before considering return to contact practice or play.  Withholding the athlete for a prolonged period of time or even permanently should be considered with a history of multiple stingers and/or persistent neurological findings, such as weakness.

Authors: AMSSM Members Kyle V. Goerl, MD; Cindy J. Chang, MD

References

1.        Chao S, Pacella MJ, Torg JS. The pathomechanics, pathophysiology and prevention of cervical spinal cord and brachial plexus injuries in athletics. Sports Med. 2010;40(1):59–75. doi:10.2165/11319650-000000000-00000.

2.        Kasow DB, Curl WW. “Stingers” in adolescent athletes. Instr Course Lect. 2006;55:711–6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16958504. Accessed March 20, 2014.

3.        Weinberg J, Rokito S, Silber JS. Etiology, treatment, and prevention of athletic “stingers.” Clin Sports Med. 2003;22(3):493–500. doi:10.1016/S0278-5919(02)00057-1.