Description:
Stinger and burner injuries, also known as brachial plexus injuries, occur commonly in contact sports such as football, rugby, and wrestling. These injuries involve trauma to the brachial plexus, a network of nerves that originate from the cervical spine/ neck and innervate the shoulder, arm, and hand.
Anatomy:
The brachial plexus is a complex network of nerves formed by the four cervical/neck nerves (C5-C8) and the first thoracic (upper back) nerve (T1). These nerves travel through the neck, shoulder, and arm, branching out to supply motor and sensory function to the muscles and skin of the upper limb.
Mechanism of Injury:
Stinger and burner injuries typically occur when the head and neck are forcefully and suddenly moved sideways, causing stretching or compression of the nerves in the brachial plexus. This can happen during tackles, collisions, or falls, leading to a sharp, shooting pain down the arm. It may also be caused by a direct blow to the area above the clavicle/collarbone.
Stingers and burners can range from mild where pain lasts for a few minutes up to severe injuries. With any neck injury it is important to rule out more serious conditions such as neck fractures, spinal cord injury, blood vessel damage and in the case of head injuries, concussions.
- The signs and symptoms of stinger and burner injuries are listed below
- Sudden, intense pain radiating down the arm.
- Numbness or tingling in the arm or fingers.
- Weakness in the affected arm.
- Difficulty in moving the arm or shoulder.
- Depressed shoulder.
- Wasting/Atrophy/Observable loss of muscle mass
- Shaking of upper limb
- Holding extremity close to body.
- Burning sensation along the nerve pathway
- Loss of sensation or feeling in the arm or hand
- The Physiotherapy Assessment should be a detailed subjective and objective evaluation and should include but is not limited to:
- A thorough history including the mechanism of injury.
- Observation for indication of muscle wasting or weakness.
- Postural assessment
- Sensation tests.
- Reflexes.
- Strength testing
- Neck, shoulder and elbow active range of motion assessment
Physiotherapy management is aimed at reducing pain and regaining strength and mobility to ensure a successful return to sport or work. This can be achieved through:
- Rest and Immobilization: Resting the affected arm and avoiding activities that exacerbate symptoms is crucial in the initial phase of recovery. Immobilization in the form of a sling may be required in severe cases where pain is easily triggered by movement.
- Ice: The application of ice over painful and swollen areas may help alleviate inflammation.
- Soft tissue massage: This will assist in reducing muscle spasm and regaining mobility.
- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics may be prescribed by your GP to manage pain and inflammation in the acute phase of injury.
- Strengthening: Gradual strengthening will be important to regain optimal function of the upper limb.
In conclusion, stinger and burner injuries can be debilitating, but with prompt assessment and comprehensive management, most individuals can achieve full recovery and return to their pre-injury level of function. Early intervention, appropriate rehabilitation, and preventive measures are key in optimizing outcomes and reducing the risk of long-term complications
References
Meyer, S., Schulte, K., Callaghan, J., Albright, J., Powell, J., Crowley, E. and El-Khoury, G. (1994). Cervical Spinal Stenosis and Stingers in Collegiate Football Players. The American Journal of Sports Medicine, [online] 22(2), pp.158-166.
Nissen SJ, Laskowski ER, Rizzo TD Jr. Burner syndrome: recognition and rehabilitation. Phys Sportsmed 1996; 24:57.
Poindexter, D.P. and Johnson, E.W., 1984. Football shoulder and neck injury: a study of the" stinger". Archives of physical medicine and rehabilitation, 65(10), pp.601-602.
Pujalte, George G. & Floranda, Eric. (2012). Stingers and Burners. Athletic Therapy Today. 17. 24-28. 10.1123/ijatt.17.1.24.
Weinstein SM. Assessment and rehabilitation of the athlete with a "stinger". A model for the management of noncatastrophic athletic cervical spine injury. Clin Sports Med 1998; 17:127.
