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
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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 Type & Select Correct Answer 1 Deltoid and biceps 91% (5795/6357) 2 Triceps 2% (124/6357) 3 Wrist flexors 2% (113/6357) 4 Finger flexors 1% (71/6357) 5 Interossei 3% (219/6357) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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 Type & Select Correct Answer 1 Determine if the pain has resolved and fit the player with a protective brace 0% (10/3515) 2 MRI of the right shoulder and neck showing no nerve root avulsions 1% (26/3515) 3 No pain, normal sensation, demonstration of full range of motion, and 5/5 strength of the right upper extremity musculature 95% (3351/3515) 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% (100/3515) 5 Normal findings on an EMG of the right shoulder and arm 0% (9/3515) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (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 Type & Select Correct Answer 1 Unilateral symptoms do not resolve within 15 minutes. 11% (337/3157) 2 Symptoms follow a short period of loss of conciousness. 3% (92/3157) 3 Player has had unilateral symptoms on two prior occasions. 7% (230/3157) 4 Transient unilateral weakness in the deltoid and biceps is present. 2% (77/3157) 5 Symptoms and physical exam findings are found in both upper extremities. 76% (2410/3157) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (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 Type & Select Correct Answer 1 Bilateral upper extremity sensory symptoms 6% (134/2173) 2 Bilateral upper extremity weakness 2% (34/2173) 3 Unilateral upper and lower extremity sensory and motor symptoms 4% (90/2173) 4 Unilateral upper and lower extremity weakness only 1% (15/2173) 5 Unilateral upper extremity pain and weakness 87% (1881/2173) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic
All Videos (0) Podcasts (1) Knee & Sports | Burners & Stingers Knee & Sports - Burners & Stingers Listen Now 14:50 min 2/25/2020 364 plays 5.0 (1)