Burner

Thomas Barwick / Getty Images

A burner, also called a stinger, is a common injury in contact sports, especially football.  Burners is football participants is 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. 

Burner: What Is Happening?

The exact mechanism of the injury is not exactly 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.

Burner Symptoms

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 weeks or longer to resolve.

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 resolved.

Treatment of a Burner

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 (parasthesias)
  3. Normal tests, including Spurling's test
  4. Normal strength testing

Prevention can be accomplished by strengthening of the neck and shoulder muscles.  In addition, some football players will use special 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 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 persistant symptoms.

Also Known As: Stinger

Sources:

Aval SM, Durand P, and Shankwiler JA. "Neurovascular Injuries to the Athlete’s Shoulder: Part I" J Am Acad Orthop Surg April 2007 ; 15:249-256.

Continue Reading