Updated: 6/2/2021

Burners & Stingers

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Flashcards
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Questions
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Evidence
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  • summary
    • Burners and stingers (also known as "dead arm syndrome") refer to a transient brachial plexus neuropraxia that most commonly occur due to a direct traumatic or tractional injury in contact sports.
    • Diagnosis is made clinically with a neurological examination most commonly consistent of unilateral tingling in the arm with transient weakness in C5, C6 muscles (deltoid, biceps).
    • Treatment is typically observation and return to play if symptoms completely resolve. Players are not allowed to return to play in the setting of persistent or bilateral symptoms.
  • Epidemiology
    • Demographics
      • common in collision sports such as football
      • having 1 stinger increases risk of another by 3X
  • Etiology
    • Pathoanatomy
      • neurapraxias are caused by different mechanisms including
        • traction injury
          • occurs by downward displacement of arm and bending of neck away from side of injury
        • compression injury
          • occurs by lateral head turning toward affected side
        • direct blow
          • can cause injury with blow at Erb's point superior to the clavicle
  • Anatomy
    • Brachial plexus
      • with motor and sensory innervation
  • Presentation
    • Symptoms
      • unilateral tingling in arm not typically isolated to a single dermatome
      • usually resolve quickly in 1-2 minutes
    • Physical exam
      • full cervical ROM
      • no tenderness
      • unilateral transient weakness in C5, C6 muscles (deltoid, biceps)
      • can have positive Spurling test
  • Imaging
    • Radiographs
      • usually unremarkable
      • C-spine images indicated with recurring symptoms
        • to rule out fx and cervical stenosis
    • MRI
      • indicated whenever symptoms are bilateral (inconsistent with stinger)
        • to rule out cervical spine pathology such as herniated disc or cervical stenosis
    • EMG
      • indicated if symptoms persist after 3 weeks
        • will show abnormalities in roots, cords, trunks, and peripheral nerves
  • Treatment
    • Nonoperative
      • return to play
        • a player may return to play when
          • complete resolution of symptoms
          • normal strength and range of motion
        • contraindications to return to play include
          • bilateral symptoms
          • recurring symptoms
            • until cervical spine xrays are obtained
    • Prevention
      • try different neck collars for football players

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(SBQ12SP.35) A 16-year-old male football player is tackled into the ground during a game. He comes to the sideline with unilateral upper extremity pain, burning dysesthesias, and muscle weakness. Several minutes later, his symptoms resolve. In this scenario, what muscles are most likely to be affected?

QID: 3733
1

Deltoid and biceps

91%

(5381/5905)

2

Triceps

2%

(117/5905)

3

Wrist flexors

2%

(100/5905)

4

Finger flexors

1%

(65/5905)

5

Interossei

4%

(209/5905)

L 1 C

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(OBQ10.9) An 18-year-old football player comes off the field after sustaining a stinger to his right shoulder. Which of the following conditions must be met before he should be allowed to return to play?

QID: 3097
1

Determine if the pain has resolved and fit the player with a protective brace

0%

(8/2959)

2

MRI of the right shoulder and neck showing no nerve root avulsions

1%

(19/2959)

3

No pain, normal sensation, demonstration of full range of motion, and 5/5 strength of the right upper extremity musculature

95%

(2821/2959)

4

Normal sensation in the right hand over the thumb, long finger, and small finger, no residual pain, and the ability to raise the right hand above his head

3%

(88/2959)

5

Normal findings on an EMG of the right shoulder and arm

0%

(6/2959)

L 1 C

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(SBQ07SM.36) In college level football players with symptoms of arm numbness and tingling following contact, which of the following is an indication for a cervical MRI prior to return to play?

QID: 1421
1

Unilateral symptoms do not resolve within 15 minutes.

11%

(286/2709)

2

Symptoms follow a short period of loss of conciousness.

3%

(80/2709)

3

Player has had unilateral symptoms on two prior occasions.

7%

(202/2709)

4

Transient unilateral weakness in the deltoid and biceps is present.

2%

(62/2709)

5

Symptoms and physical exam findings are found in both upper extremities.

76%

(2069/2709)

L 2 C

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(OBQ04.99) A football player is diagnosed as having a "stinger" by the athletic trainer. Which of the following acute transient findings would be consistent with that diagnosis?

QID: 1204
1

Bilateral upper extremity sensory symptoms

6%

(117/1967)

2

Bilateral upper extremity weakness

2%

(31/1967)

3

Unilateral upper and lower extremity sensory and motor symptoms

4%

(79/1967)

4

Unilateral upper and lower extremity weakness only

1%

(15/1967)

5

Unilateral upper extremity pain and weakness

87%

(1707/1967)

L 1 D

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EXPERT COMMENTS (7)
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