Posted on June 13, 2009 to AOC Physician Articles
Dr. Clayton G. Lane, MD
One half of college football players will experience a stinger injury at some point during their career. Because, it sometimes results in temporary paralysis of the arm, it can be quite concerning for the athlete, coach and family members. In most cases however, there are no permanent limitations following the stinger (or Burner) syndrome episode.
All of the nerves that go to the arm come from a web of nerve roots exiting the spinal cord at neck level called the brachial plexus. This web of nerve roots coalesce into a nerve just like the roots of a tree into a tree trunk. Therefore, any injury to the brachial plexus results in variable nerve dysfunction in the arm dependent on which roots or cords are injured.
The stinger is almost exclusively a football injury because of the nature of the game. The brachial plexus runs to the arm just deep to the clavicle. Therefore, every time a player puts his shoulder into a tackle the plexus is at risk. The classic stinger injury occurs when the player takes a hard hit to the top of the shoulder while the head is turned to the opposite side. This places a stretch on the brachial plexus which can result in simple stretch, partial tearing or complete tearing of the nerves. The player typically experiences instantaneous burning pain in the arm. This pain may be associated with weakness of the arm that is apparent immediately or may present over the next few hours or days.
In most cases in which only a stretch has occurred, the athlete has resolution of pain and weakness within 15 minutes. The athlete should only be allowed to go back into the game if he has no pain and full strength on examination by a physician or trainer. In a small amount of cases recovery of full strength can take two weeks with partial tearing or up to a year with complete tearing of nerve tissue. With all stingers there is a recurrence rate up to 90%, so preventative measures should be taken.
High quality shoulder pads, ‘cowboy collars’ and shoulder strengthening have all been recommended as prevention strategies. If an athlete experiences recurrence despite these measures, a full evaluation by an orthopedist for cervical spine abnormalities should be performed. Also, any athlete experiencing symptoms of pain or weakness in both arms at the same time should be placed on spinal precautions for possible spinal cord injury, because stingers do not occur in both arms at the same time.