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Burner or Stinger

Definition

A burner is an injury to the bundle of nerves that runs from the back of your neck into your arm. These separate nerves come together in the upper shoulder to form the brachial plexus. From here, the nerves go to all the arm muscles. A burner is often called a stinger.

Brachial Plexus

Causes

A burner may be caused by:

Stretching of the Brachial Plexus Nerves

This can be caused by your shoulder being pushed down while your head is forced to the other side.

Pinching of the Brachial Plexus Nerves

This can happen if your head is moved quickly to one side.

Bruising of the Brachial Plexus Nerves

This can happen when the area above your collarbone is hit directly or pressure on the top of your head compresses the brachial plexus nerves against bone.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for a burner (stinger) include:

Playing American football—due to receiving direct blows to the head, neck, and shoulders
Participating in contact sports

Symptoms

Symptoms may include:

Burning or stinging feeling between your neck and shoulder
Burning or stinging feeling in one arm
Numbness, tingling, or weakness in the shoulder or arm

Diagnosis

The doctor will ask about your symptoms and how the injury occurred. One of the most important questions is whether symptoms occur in one arm only or in both arms at the same time. Bilateral symptoms (or especially symptoms involving all four limbs) are potentially more serious and need more extensive medical evaluation.

The doctor will examine you for:

Pain or tenderness
Neck and arm range of motion
Strength in the arm and hand
Arm reflexes
Sensation in the shoulder and hand

For serious burners you may have an electromyogram (EMG) to verify the diagnosis and determine the extent of the injury.

Treatment

Some burners last only a few minutes and won't require treatment. Others may require physical therapy to strengthen your muscles while you wait for the nerve to heal itself. The decision to return an athlete to play after a burner requires careful evaluation that assures complete recovery has occurred and that there are no serious conditions that could lead to reinjury.

Some sports physicians will want an MRI or EMG study before approving return of an athlete who has suffered a burner. Multiple burner injuries in one season may be reason to restrict return to play and should generally result in referral to an experienced sports medicine physician for evaluation.

Prevention

One of the important goals in evaluation and management of burners is to recognize those injuries which could represent far more serious cervical spinal cord damage. Early recognition of this condition can prevent subsequent reinjury and possible paralysis. Careful post-injury evaluation and assurance that only one arm is symptomatic can help prevent permanent damage.

Keeping the muscles around your neck and shoulders strong and flexible will help you withstand the stress of a direct blow. Learning safe sports technique is essential. Avoid using your helmet as a contact point when tackling and blocking in football. Always make sure to wear the proper safety equipment for your sport. Pads and other modifications of athletic gear have been proposed in an effort to reduce the incidence of burners. These may be especially useful for players who have previously suffered injury.

RESOURCES:

American Academy of Orthopaedic Surgeons
http://www.aaos.org/

American Orthopaedic Society for Sports Medicine
http://www.aossm.org/

CANADIAN RESOURCES:

Family Phsyician
http://www.cfpc.ca/global/splash/default.asp?s=1/

Health Canada
http://www.hc-sc.gc.ca/index-eng.php/

REFERENCES:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html

Dimberg EL, Ted M. Burns TM. Management of common neurologic conditions in sports. Clinics in Sports Medicine. 2005;24(3).

Kasow DB, Curl WW. "Stingers" in adolescent athletes. Instr Course Lect . 2006;55:711-716.

Mayo Foundation for Medical Education and Research website. Available at: http://www.aafp.org/online/en/home.html

Weinberg J, et al. Etiology, treatment, and prevention of athletic "stingers". Clin Sports Med . 2003 Jul;22(3):493-500, viii.

Last reviewed September 2009 by Rimas Lukas, MD
Last Updated: 9/30/09

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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