Stinger (or Burner) Injury

What is it?

A "stinger" (also called a "burner") injury is a very common injury among football players and other athletes. Almost 8% of football players report having had at least one "stinger" injury. A stinger is an injury to the web of nerves that comes out of the spinal cord in the neck on its way to the shoulder, chest, and arm. It usually happens during a tackle. The athlete’s shoulder or shoulder pad gets pushed up and inward against the neck. This puts sharp pressure on the nerves just at the point where they are closest to the skin surface. Those nerves provide feeling and control to the skin and the muscles of the shoulder and arm. At the moment of the injury, the athlete feels shooting pain, numbness, and/or tingling down one arm. This usually lasts less than one minute. Some athletes may have muscle weakness that lasts for several more minutes.

Stingers frequently recur, and they can lead to long-term nerve problems. Athletes who have only one stinger usually have normal structures in their spinal columns, but those who experience more than one are likely to have narrowing of the spinal canal. This can put them at risk for much more serious neck and spinal cord injuries.

The biggest concern in any injury that involves the neck is to be sure there’s no damage to the spinal column or spinal cord. Your doctor will have decided whether or not to do X-rays or other tests to look for a more serious injury. S/he will also ask you to follow these Aftercare Instructions carefully, and to return at once if any new or worrisome symptoms appear.

The first step in treating a stinger is to be sure there’s no other injury. If the history of the injury is clear, and the athlete has no signs or symptoms by the time the doctor sees him or her, there may be no need for X-rays or scans. If there’s any question at all, your doctor will order the necessary tests. Your athlete should stay completely out of competitive sports until your doctor clears him or her to return. This will usually be between 3 days and one week in the case of a first time stinger. If your athlete has a repeated stinger injury, please discuss the next steps with your doctor and keep the athlete out of play until you’ve reached a decision.

A football player who has had a stinger should request to work with a coach or trainer on improving tackling techniques. Other athletes should also work to develop techniques that don’t cause their shoulders to be pushed up against their necks, or their necks to become sharply flexed to the side. Many football players who have experienced one stinger will use an "orthotic" device. This is a specially fitted pad that helps keep the shoulder pads from pushing into the side of the neck during a tackle.

A stinger is an injury to the nerves of the neck, so it naturally causes concern. Because some more serious neck injuries can appear like a stinger at first, your doctor will ask you to look out for the following things:

• Neck pain
• Back pain
• Difficulty breathing, speaking, or swallowing
• Changes in the sound of the voice
• Loss of bowel or bladder control
• Persistent numbness, tingling, or pain in the arm
• New numbness, tingling, or pain in any part of the body
• Other abnormal nerve symptoms such as a feeling of warmth or flushing in the arm, or an abnormally cool, dry arm
• Weakness in the arm that gets worse rather than better

Most doctors will want to do CT or MRI scans of the neck bones and spinal cord if the athlete has recurrent stinger injuries. Such athletes may have potentially dangerous narrowing of the spinal canal. People with narrow spinal canals can suffer permanent spinal cord damage from relatively mild neck injuries. Many doctors will recommend not playing competitive contact sports if an athlete has recurrent stingers and there is evidence of spinal canal narrowing. This can seem like a catastrophe to a competitive young athlete (or his or her parents). Please have a careful and patient discussion with both your doctor and your athlete about the risks of serious spinal cord injury. It can result in weakness or paralysis of one or more than one extremity. It can cause permanent loss of bowel and bladder control. It can cause sexual dysfunction. Despite some encouraging advances in medicine, spinal cord injury is still a permanent condition. You and your athlete should carefully weigh the risks of permanent injury against the benefits of continuing in competitive play.

As we’ve stressed, a stinger injury is a diagnosis that doctors make when there is evidence of a temporary, passing injury to nerves. This always raises the question of whether there’s another, more serious injury such as a broken bone or a spinal cord injury. You and your doctor will want to be very sure you rule out any such serious injury. A stinger is, by definition, temporary and clears up on its own. If your athlete has continued or new symptoms, s/he probably has something more serious that needs evaluation.