BURNERS/STINGERS

Burners, otherwise known as stingers, are injuries to the brachial plexus that cause a loss of neurologic function in the affected arm. These injuries are most common to football. The mechanism of injury is usually the head forced into lateral flexion and the shoulder is depressed away from the head and neck. This cause of traction on the brachial plexus can cause various degrees of damage. The athlete will notice a sharp burning shoulder pain that often radiates down the arm into the hand. The athlete will sometimes try to "shake off" the injury to restore feeling to the affected upper extremity. Weakness may be present at the time of injury and the athlete may leave the field supporting the injured extremity. The weakness is usually transitory and may resolve within a few minutes. In some instances, the weakness may not develop until hours or days after the injury. There is no neck pain or significant restriction in neck mobility usually associated with a true burner. In the presence of neck pain, a more serious injury to the cervical spine should be evaluated.

Injuries to the brachial plexus are classified according to severity:

Grade 1 (neurapraxias) injuries are the most common brachial plexus injuries, which represent a minor compression or contusion to the peripheral nerve with transitory loss of motor and sensory function that last from a few minutes to 4 weeks. Full recovery can be expected.

Grade 2 (Axonotmesis) injuries are when the nerve fiber is partially transected, and motor and sensory dysfunction is complete at the time of the injury. A complete recovery can be expected within 2 to 3 months.

Grade 3 injuries are rare and are a complete severing of the nerve fibers. Individuals that suffer this injury may exhibit motor and sensory loss at 1-year post injury without clinical improvement.

Treatment of grades 1 and 2 injuries involves removing the athlete from participation as long as symptoms or weakness to manual muscle testing persist. Return to play in this condition can result in further irreparable damage to the brachial plexus resulting in permanent disability. The athlete should be placed on a neck and shoulder muscle-strengthening program as soon as tolerated. Return to contact sport is based on the athlete regaining strength and endurance of the shoulder muscles to normal as compared to the uninjured side. The athlete should have no sensory dysfunction. When returning to football, the use of a neck roll or cowboy collar to prevent lateral flexion of the neck and wearing built up shoulder pads may reduce the incidence or recurrent burners.

Any Grade 2 or 3 injuries should receive further evaluation by an orthopedic surgeon or neurologist. A safe return to athletic competition may be achieved with the proper treatment and management of these injuries.

If you have any additional questions with regards to burners/stingers, please feel free to call a physical therapist at East Suburban Sports Medicine Center.

Brian Bernasconi, ATC