Shoulder Pain

Burners and Stingers

What does it actually mean?

Burners and stingers are common injuries in contact or collision sports. A burner or a stinger is an injury to the nerve supply of the upper arm, either at the neck or shoulder. The injury is named for the stinging or burning pain that spreads from the shoulder to the hand. This can feel like an electric shock or lightning bolt down the arm. In most cases, burners and stingers are temporary and symptoms quickly go away.

Burners 1           Burners 2

Mechanisms of "burners." (A) Traction to the brachial plexus from pushing the shoulder down and forcing the neck the other way. (B) Direct blow to the side of the neck at what is known as 'Erb's point'. (C) Compression of the nerves from forcing the neck to bend and tip backwards (Kuhkman & Mckeag 1999 AAFP)

Anatomy

  • Nerves are like electrical cables that travel through the spinal canal carrying messages between your brain and muscles.
  • The nerves that provide feeling and movement to the arm 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. All of the nerve supply to the arm runs through this plexus.

What Causes these Burners & Stingers?

  • An injury to the brachial plexus can cause a burner or stinger. This often happens when the head is forcefully pushed sideways and down.
  • This bends the neck and pinches the surrounding nerves.

Risk Factors

  • Contact sports: Athletes who engage in contact sports are more likely to suffer a burner or stinger. In fact, up to 70 percent of all individuals in contact sports have experienced this problem in their sporting careers.
  • Trauma: Burners and stingers often occur with a fall onto the head, such as in a wrestling takedown or a football tackle. In fact, tackling or shoulder charging in Rugby most often causes these burners and stingers.
  • Spinal stenosis: In addition to playing contact sports, a small spinal canal may put you at greater risk for a burner or stinger. Athletes with recurrent stingers or burners may have smaller spinal canals than players who do not suffer recurrent injury. This condition is called spinal stenosis.

What are the signs & symptoms?

Symptoms typically occur in one arm only. They usually last seconds to minutes, but in 5% to 10 % of cases, they can last hours, days, or even longer. The most common symptoms of a burner or stinger include:

  • A burning or electric shock sensation
  • Arm numbness and weakness immediately following the injury
  • A warm sensation

In order to determine whether your injury is a burner or stinger, we will discuss your symptoms and how the injury occurred. Imaging tests, such as x-rays, magnetic resonance imaging (MRI) scans, and nerve studies are not usually needed. A more extensive examination is needed if you have any of the following symptoms:

  • Weakness lasting more than several days
  • Neck pain
  • Symptoms in both arms
  • History of recurrent stingers/burners

How do I manage this problem?

Treatment begins by removing the athlete from further injury. Athletes are not allowed to return to sports activity until their symptoms are completely gone. This can take a few minutes or several days. Athletes should never be allowed to return to sports if they have weakness or neck pain.

If you have had recurrent stingers, you may need a special neck roll or elevated shoulder pads to wear during sports activities.

Although the injury gets better with time, you may need to work with a trainer or therapist to regain strength and movement if the symptoms last for several days.

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