The Fan's Guide to Sports Injuries

Stingers and Burners: Brachial Plexus injury

Stingers/Burners are a common injury occurring in contact sports, most notably football players. A stinger is an injury caused by a sudden jolt to the nerves in the neck (Brachial Plexus) that supply the arm. Studies show that 50%-65% of college football players will report having a stinger at some point in their college career. The injury occurs quite commonly after a big hit or tackle; a defensive player is seen running off the field shaking his hand and/or arm while bending their neck to the side. Bending the neck seems to alleviate the symptoms by reducing the tension on the nerves involved. The injury is so named a stinger or burner because of the sensation that travels from the neck down the arm: a stinging or almost electric shock-like sensation. It usually resolves in seconds to minutes, but in some cases symptoms can last days or weeks.

On-field injury

The force of the hit causes sudden traction to the nerves in the neck, resulting in a shock-like sensation. Typically what occurs is that the player attempts to hit his opponent by leading with his shoulder; upon contact, the shoulder is depressed and the player's head is bent away from the shoulder, resulting in tension or traction force on the nerves that flow from the neck into the arm. This sudden stretching-type force causes the stinging sensation to travel down the arm to the areas the nerve supplies. Because of the mechanism of this injury occurs during tackling, it is most common for defensive players to acquire, especially linebackers and defensive backs.

Evaluation of injury

Upon initial examination of the athlete, the sports medicine team needs to rule out a few injuries that would be more severe and affect treatment or return to play. Since it is quite common for athletes to re-enter the same game after a stinger, it is important to make sure there isn't something more complicated occurring. The more complicated injuries that may mimic a stinger include spinal cord injury, clavicle fracture, and shoulder dislocations. The sports medicine staff will thoroughly check the signs of a neck fracture first and foremost. With stingers the pain is typically only down one arm; if both arms are involved, this is more serious. The first part of the exam will be palpation or feeling the neck to check for anything out of the ordinary, followed by range of motion the athlete has during neck movements.

After a fracture is ruled out, the nerves will be evaluated by:

1.) Testing the strength in the muscles in the arm

2.) Appropriate response when testing reflexes at the bicep, tricep, and forearm

3.) Appropriate sensation in the different areas of the arm supplied by the nerves called dermatomes. The stinging or burning should subside before re-entry to the game.

Any alteration from the normal, compared to the unaffected side, would reveal injury to the nerves and require more attention. The sports medicine staff will then move further from the spine into the shoulder to evaluate for any fractures or dislocations that may occur, especially to the clavicle (collarbone), or scapula (shoulder blade).

Treatment/Prevention

In most cases this injury resolves in minutes, allowing the athlete to return to play in the same game. In instances where the burning or stinging sensation remains, the athlete is removed from play and will go through a series of treatments. These treatments may include neck strengthening exercises, chiropractic manipulation, non-steroidal anti-inflammatory medication, and soft-tissue myofascial release techniques.

It is important to work on prevention of this injury; studies report it may re-occur in 86% of athletes. Prevention may include neck strengthening, chiropractic manipulation, improving posture, improving tackling form, and promoting better positioning when going in for the tackle. The proper technique involves tackling or blocking from a more vertical, upright position. Spearing (tackling with the crown of the helmet), should be discouraged; it can put the athlete in a more compromised position for not only stingers but further neck injury. Appropriate fitting of the shoulder pads is important as well as using a neck roll or other device to limit excessive neck movements. These have not been shown to prevent stingers or recurrence of stingers, but they may have an effect in reminding the athlete to tackle with correct form.

Returning to full contact depends on pain-free, full passive and active range of motion of the neck and shoulder and normal neurologic examination results, including full and symmetric strength of the shoulders and neck.

This injury, although maybe not the most serious of injuries a football player can sustain, shouldn't be taken lightly. It may mimic further more complicated injuries and as a result is meticulously evaluated by the sports medicine staff.

Michael Tunning D.C., ATC

Dr. Tunning is a faculty member at Palmer College of Chiropractic in the Diagnosis and Radiology Department. He also is an Associate at Chiropractic Healthcare Associates in Cedar Rapids, IA focusing in all musculoskeletal injuries as well as athletic injuries. Dr. Tunning is a member of the Iowa Athletic Trainer's Society, the Iowa Chiropractic Society and is a member of the American Chiropractic Association's Sports Council working as the liaison to the National Athletic Trainer's Association.

For more information please visit www.chiroassoc.com