The Burner/Stinger Football Injury

A burner, also called a stinger, is a common injury in contact sports, especially football. Burners in football participants are extremely common, with over 50% of all athletes reporting at least one episode of a burner occurring over the span of their career – some with repeated episodes. 

The exact mechanism of the injury is not precisely known, but a burner is thought to be due to either stretch or compression, or a combination of both, of the brachial plexus. The brachial plexus is a network of nerves that has just exited the spinal cord. These nerves travel across the shoulder and into the arm.

When a nerve is aggravated, it begins to act abnormally. This may mean patients can experience pain, numbness or weakness, or all of these symptoms. Typically the athlete's neck is stretched away from the affected shoulder, as might occur during a collision or fall to the ground. When the upper shoulder area strikes the ground forcefully, the head and neck may pull to one side, and the shoulder pushed to the other. The resulting stretch on the shoulder may cause injury to the brachial plexus.

Symptoms of a burner are sudden pain and tingling extending from the neck and down the arm into the fingers. This symptom is the typical burner complaint from an athlete. Often athletes will be found to have weakness of the affected arm, although weakness may take several hours to show up, and may take days, weeks or even longer to resolve. Most typically, symptoms resolve within a few minutes or hours. The reason some people refer to the injury as a burner is an often-experienced symptom of a warm or hot rush extending down the arm.

Burner injuries have been classified on a grading scale as grades 1, 2, and 3. While the grading is often inconsistent between different clinicians, a grade 1 injury typically is back to normal within a few weeks, whereas a grade 3 injured athlete may have symptoms for a year or longer.

Athletes who sustain a burner should be immediately evaluated by a clinician or medical personnel trained in these injuries. The evaluation should include testing of sensory abnormalities and muscle weakness. Any athlete with findings of numbness or weakness should not return to participation until symptoms have completely resolved. In cases where the symptoms persist or are more severe, further testing may be needed to evaluate for other possible causes of numbness and weakness such as a herniated disc or spinal nerve injury. Tests may include x-rays, MRIs, or nerve conduction studies; however, most commonly these tests are not necessary.

There is little to be done for treatment of a burner, although some therapeutic activity including light stretching and strengthening may be helpful. In order to return to sports, athletes having sustained a burner should have achieved the following:

1. Normal range-of-motion of the neck and arm
2. Resolution of abnormal sensations (paresthesias)
3. Normal tests, including Spurling's test
4. Normal strength testing

Prevention can be accomplished by strengthening the neck and shoulder muscles. In addition, some football players will use special pads or collars ("cowboy collars") to prevent excessive stretch of the brachial plexus and hopefully prevent recurrent stinger injuries.

It is important that athletes who have symptoms not typical of a burner, or athletes who have unresolved symptoms, have an evaluation to determine if there is another cause of their symptoms. There are conditions of the neck and spinal cord that can mimic symptoms of a burner, and these need to be considered in athletes with more severe or more persistent symptoms.