The terms stinger injury and burner injury can be used interchangeably. Burners are often referred to as stingers. They are intense nerve pains that run through the neck and shoulder when the nerves become stretched or compressed after some kind of injury. That’s why they are common sports injuries. Although frightening, they usually resolve quickly within minutes. But in five to ten percent of cases, they can last hours, days, or even longer. Some stingers may heal on their own, others may result in lifelong disabilities, including permanent damage to the nerve and paralysis of the arm. When you first get the shock from a stinger or burner, you may think it’s nothing. But if you think a burner or stinger is something you’ve experienced, it’s well worth learning everything about them, and the best place to start is OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado.

OVERVIEW

Stingers (or burners) are injuries affecting the network of nerves that run from the top of your spinal cord down through your neck, shoulders, and arms. This network is called the brachial plexus, so burners and stingers are sometimes called brachial plexus injuries. Stingers and burners occur mostly in athletes who play contact sports, particularly football. It’s reported that 65% of college football players have had burner injuries before. Burners have also been known to reoccur as frequently as 87% according to some studies. Usually, only one arm is affected.

ABOUT THE BRACHIAL PLEXUS

Nerves are like electrical cables that travel through the spinal canal carrying messages between the brain and muscles. The nerves that provide feeling and movement to the arms branch out of the spinal canal at the neck. They join together to form a larger bundle, or cord, of nerves. This cord is called the brachial plexus. When this complex network of nerves exits the neck, they “perform a dance” where the nerves join, blend, branch, and then separate. These now mixed nerves transfer through the front of the chest under the collarbone and descend into the arms. This transmits signals responsible for motor and sensory stimulation of the upper extremities, including the shoulder, arm, and hand.

WHAT ARE BURNERS AND STINGERS?

If a nerve is stretched, it may simply recoil to its original length when the stretching force is released. If the stretch is substantial, the nerve may completely snap, similar to the stretch and snap of a rubber band. In general, a nerve can stretch about 6% of its length without injury. Stretching between 6% and 15% will cause temporary damage to the nerve. With a stinger, when the nerve cell is injured, generally the membrane of the nerve can be “stunned” (a temporary “concussion” to the nerve). The nerve may suffer either reversible or irreversible damage. The insulation or plasma membrane wrapping the nerve (myelin sheath) can also be damaged. When the nerve cell membrane is “stunned” or damaged, the signal can be blocked which prevents the message from continuing down the nerve.

CLASSIFICATIONS OF STINGERS AND BURNERS

There are three classifications of brachial plexus stingers beginning with the mildest classification as a Grade I injury and progressing in severity through to a Grade III injury. 

• Grade I stinger or burner: Grade one injury is called a neuropraxia injury and results in a temporary loss of sensation and/or loss of motor function (ability to use muscles). This is thought to occur due to a localized conduction block in the nerve bundle that prevents the flow of information from the spinal cord to the innervated areas. Because this is only a “block”, the symptoms are transient and may only last from several minutes to several days.
• Grade II stinger or burner: Grade two injuries are more significant injuries because there may be actual damage to the nerves known as axonotmesis. Axonotmesis is defined as damage to the axon of the nerve without severing the nerve. These types of injuries may produce significant motor and/or sensory deficits that last at least two weeks. Because the growth of an injured axon is a very slow process, it takes several weeks for the regrowth to occur. However, once the regrowth has occurred, full function of motor and sensory functions are restored.
• Grade III stinger or burner: The most severe plexus injury is a grade three injury. Individuals with these types of injuries may not have a full recovery and may be considered to have sustained a catastrophic injury because the neurological symptoms may last up to one year. A Grade III is known as a neurotmesis injury and is defined as a complete severance of the nerve. This type of injury has a poor prognosis and may need surgical intervention.

CAUSES

Although brachial plexus stingers have several mechanisms of injury, the most common is the brachial plexus being stretched when the head is forced to one side while the opposite shoulder is depressed. This “stretch” is enough to cause a temporary injury to the plexus resulting in transient symptoms of the shoulder, arm, and hand. This nerve bundle can also be injured through a direct blow to the side of the neck/shoulder or when the neck is extended (face to the sky) while the shoulder is abducted (arm is moved up and to the side of the body). During this type of positioning of the head and shoulder, the brachial plexus can be compressed between the clavicle and the first rib. While burners and stingers are common in contact sports such as football, they are also common in wrestling,  gymnastics, rugby, hockey, snow skiing, and martial arts. Stingers can also be the result of daily activities that lead to accidents. For example, one might get a stinger after falling off of something like a bike or a stepladder. Besides contact sports or accidents, another risk factor for stingers is spinal stenosis.

SYMPTOMS

• Sudden, sharp pain: a burning or stinging sensation that starts at the neck or shoulder and radiates down the arm
• Numbness or tingling in the arm or hand
• Temporary weakness in the affected arm or hand
• A warm feeling in the arm

NON-SURGICAL TREATMENTS

The main treatment for stingers is to rest until the symptoms go away completely and muscle strength in the arm has been recovered.  During the two days following the injury, the PRICE method should be followed:

• Protect injured area
• Rest arm and shoulder
• Ice neck and shoulders
• Compress if there is swelling — use an elastic bandage wrap
• Elevate to decrease swelling

For pain, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help

If symptoms last longer than a few days, one can consider working with an athletic trainer to recover strength and range of motion.

WHEN IS SURGERY INDICATED?

Surgery is not a treatment option for burners or stingers. Management remains conservative (nonsurgical). Patients are followed until recovery is complete.

GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.

To diagnose a stinger, your doctor will ask you for details about how the injury happened. They will also ask you about your symptoms and tell you to describe the feeling in your arm or shoulder. They will usually perform a physical examination to determine the severity of your injury. Imaging tests like nerve studies, X-rays, or MRIs typically aren’t necessary for diagnosing stingers. Your doctor may order imaging or perform a more thorough examination if you have stingers that keep coming back. It may seem like an easy condition to diagnose, but stingers need to be differentiated from other more serious issues such as nerve damage, a spinal cord injury, or a herniated disc that can often mimic a stinger. This is why you want an orthopedic specialist with extensive experience, impeccable credentials, and outstanding results, like the renowned orthopedic experts at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado. Because stingers can be reoccurring, you can trust that they will be there for you, following up and adapting your care to get you back in the game, or just out there enjoying life pain-free. Schedule an appointment with a neck or pain specialist today.