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