By Melissa Klamm, ATC
Have you or your child ever taken a hit during an athletic game or practice and immediately felt pain and tingling into one arm? If so, then you have experienced a “stinger”. A “stinger” or “burner” is a frequent nerve injury caused by trauma to the neck and shoulder during athletic participation. Stingers occur most often in football players but are also seen in wrestlers, gymnasts and hockey players. More specifically, linebackers and defensive backs are more likely than any other position to suffer a stinger.
There are varying grades of stingers: grades 1 and 2 are most common and result in minor nerve damage, grade 3 causes permanent nerve damage but is very rare in sports. The main symptoms of stingers are burning pain, numbness and weakness radiating down one arm. Sometimes the symptoms stay in the neck and shoulder area, but other times the pain and numbness can radiate as far down as the fingers. The extent and length of effects help determine the severity of the injury. Frequently, the symptoms resolve spontaneously within a few minutes.
Three main mechanisms cause stingers in sports. The first one is traction where the shoulder is pushed down and the neck is forced towards to opposite shoulder. As a result, the brachial plexus, the major complex of nerves in the junction of the neck and shoulder, is stretched. The second possible way involves a direct blow to the top of the shoulder just above the collarbone. Nerve compression, which involves neck hyperextension and bending to same side, is the most persistent and severe type of stingers.
An important part of determining the severity of a stinger involves history and physical examination. A specific account of the immediate and lasting symptoms should be obtained from an athlete who may have a stinger. The history information should include type, intensity, location, radiation, and length of pain. Also, ask the athlete about numbness and weakness. Since stingers frequently recur, it is important to note if the person has a history of previous occurrences and what treatments were used in the past. An athlete suspected of having a stinger on the field may try to shake it out or hold it against their body to lessen the pain, so pay attention to anyone who may exhibit such actions. Once spinal injuries have been ruled out, range of motion and strength of the shoulder and neck should be evaluated by a certified athletic trainer or physician. The weakness may persist from a few minutes to a few days. However, symptoms lasting longer than 24 hours should be examined by a physician. Sometimes a physician will order aMRIorCATscan, x-rays, and an EMG (test of nerve conduction from neck to fingers). With the help of specialized tests, the physician will determine the extent of damage and ability to return to play.
It is vital to rule out serious injuries of the neck and spinal cord such as cervical fractures and spinal cord contusions before further assessment is conducted. Until proven safe, any symptoms involving both arms, neck vertebral tenderness or lower extremity tingling indicate a cervical fracture or spinal cord trauma. Do not assume you only have a stinger because you may have a serious neck injury. If you have burning, tingling or numbness in your arms or legs, stop and immediately tell someone. Do not move until a certified athletic trainer or doctor examines you.
Management and prevention of stingers can be easily addressed by correcting strength deficits, improving neck flexibility, and enhancing protective equipment. Flexibility and strength of the shoulder and neck are important for prevention because stiffness and weakness are predisposing factors. Daily stretching can help improve neck flexibility. Helpful protective equipment for football include air flotation pads that raise shoulder pads higher and neck roll or Cowboy Collar to limit neck hyperextension. By raising the shoulder pads higher, the pads fit better, decrease direct pressure on the neck and improve shock absorption. The neck roll has been statistically proven to decrease the occurrence of neck injuries including stingers. Most of the preventive equipment is reasonably priced and worth trying on athletes with a history of stingers or at risk positions.
Before returning to athletic competition, several steps must be taken. The athlete should be evaluated at the time of injury and then at least weekly until symptoms resolve. The person should be seen by a physician if the symptoms persist longer than one full day or worsen over time. Range of motion and strength of the neck and shoulder must return within normal limits before a student can be cleared to play. If the athlete has been seen by a doctor, then they must be cleared by a doctor before returning to sports. The athlete must remain symptom free during practices in order to maintain participation. Stingers frequently recur. In fact, one study found 42 percent of college athletes experience recurrent stingers. The risk of permanent nerve damage from multiple stingers is unclear, but with the amount of athletes experiencing recurrent stings, the risk appears low.
Stingers most commonly happen when a football player tackles or blocks another player while stretching or compressing the neck and shoulder. Remember stingers only occur in one arm at a time, so inform a doctor or certified athletic trainer immediately if you have symptoms in both arms and/or legs. A player can return to sport participation once they have been cleared by a doctor, the range of motion and strength has returned to normal, and all other symptoms have stopped. Once an athlete has suffered a stinger, they should use effective protective equipment and use simple stretches to prevent recurrent episodes.
Image from: www.highschoolsports.al.com
Melissa Klamm, ATC is a certified athletic trainer with KORT Physical Therapy. She obtained her BSE from University of Arkansas in 2003.