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Updated: Jun 2 2021

Burners & Stingers

Images Plexus with sensory 566_moved.jpg
  • 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
          • multiple stingers 
            • until further off-field workup is completed
          • recurring symptoms
            • until cervical spine xrays are obtained
    • Prevention
      • try different neck collars for football players
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