Stingers and burners are the nicknames given to a condition called brachial plexopathy. It is common in contact sports and is caused by nerve compression from impacts to the neck and shoulder area resulting in stinging or burning sensations in the neck and arm.
Stingers and burners symptoms
- Symptoms of brachial plexopathy consist of a burning or electric shock sensation which may be felt from the neck down the arm and into the hand.
- It occurs after compression or a traumatic impact to the neck for example in football or rugby tackling.
- The sensation usually lasts only seconds or a minute or two although on rare occasions it can be much longer.
- The patient may describe a warm feeling in the arm and there may be some weakness or numbness after the initial pain has subsided.
- Stingers and burners can range from mild where the pain lasts for a few minutes, up to very severe injuries.
- With any neck injury, it is important to rule out more serious conditions such as neck fractures, spinal cord injury, damage to blood vessels or brain injury. The athlete should be immediately removed from play if there are any indications of more serious injury including concussion.
Causes & anatomy
Brachial plexopathy is a form of peripheral neuropathy caused by damage to the brachial plexus. The brachial plexus is a bundle of nerves which exit the spinal column between the C5 and T1 vertebrae and then down into the shoulder, through the arm and into the hand.
The injury usually occurs when the head is forced to the side as the shoulder is forced downwards, such as during a tackle or a fall onto the shoulder or head. This causes a traction injury to either the nerve routes in the neck or the brachial plexus. Another mechanism of injury is from compression from a direct blow to the nerves in the brachial plexus.
Treatment for stingers and burners
Immediate treatment for a brachial plexus injury is to stop playing or training until symptoms of numbness, weakness, stinging or burning sensations have gone. This may be only a few minutes, or it may mean avoiding all physical contact sports for a longer period of time.
If symptoms persist for longer than 2 days, visit a Doctor. Usually, an examination and discussion of the injury are all that is needed for a diagnosis but where symptoms are more long-lasting or severe, MRI, CT scans or nerve conduction studies may be required. For those with recurrent stingers or burners, elevated shoulder pads or a neck roll may be recommended to prevent over-stretching and impact to the area.
For patients with recurrent stingers and burners, a gentle exercise program can begin as soon as symptoms allow, but all activities which trigger symptoms should be avoided. Be patient! Nerve injuries sometimes just need a period of rest in order to recover and no amount of exercise will speed up the healing process.
- Liu JX, Thornell LE, Pedrosa-Domellöf F. Muscle spindles in the deep muscles of the human neck: a morphological and immunocytochemical study. J Histochem Cytochem 2003;51: 175–86.
- Hoy D, March L, Woolf A et al. The global burden of neck pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014;73(7):1309–15.
- Safran MR. Nerve injury about the shoulder in athletes, part 2: long thoracic nerve, spinal accessory nerve, burners/ stingers, thoracic outlet syndrome. Am J Sports Med 2004;32(4):1063–76.