Burners, Stingers, and Acute Brachial Plexus Injuries

The brachial plexus is a collection of nerves on each side of the neck. The bulk of the structure is found in the lower neck although it originates from the spinal cord and extends into the armpit. The brachial plexus has many subdivisions and provides the nervous input and output for the chest, shoulder, arm, and hand.

Burners, stingers, and acute brachial plexus injuries are synonymous terms for a relatively common injury that affects the nerves of the upper extremity. Although the most common cause of injury is from tackling, burners can result from any insult to the neck and shoulder. Injuries often result from pulling or compression of the brachial plexus or of cervical nerve roots 5 or 6. Typically burners will resolve spontaneously, but the risk of recurrence is fairly high. Rarely do these injuries lead to any permanent disabilities.

Three mechanisms exist for brachial plexus injuries. The first is traction, or stretch, injury that occurs when the shoulder is depressed and the neck is forced to the opposite side. The second mechanism involves a direct impact to the upper trunk of the brachial plexus. The third results from a combination of hyperextension of the neck and lateral flexion of the head. The third mechanism tends to cause the most severe symptoms of the three.

Typically, burners present as radiating pain down one arm which begins immediately after an inciting incident. Pain usually starts above the clavicle and spreads down the arm in a circumferential pattern. There may also be numbness or weakness at the time of injury, but this may develop several hours to days after the initial injury. Pain often resolves within one or two minutes, however, full recovery can take weeks to months. While many cases will be evaluated at time of injury (especially when sports-related), it is important to be reevaluated by a physician until symptoms resolve. Athletes should return to sport once symptoms have fully resolved and are not exacerbated by movement.

To help reduce the chance of reoccurrence, improving strength and flexibility can help, as stiffness and weakness of the neck, shoulder, and upper extremity can predispose athletes to injury. Proper posturing is equally important, as this can help enhance the openings through which the nerves exit the spinal column, as well as reduce the compression on the neck and nerve roots caused by the weight of the head.

If you have or have had a brachial plexus injury, call to set up an appointment at Scottsdale Sports Medicine Institute for evaluation and prevention of future episodes.

Contact:

Jeff Dahl – Patient Engagement Director

Office - 480.664.46415, jeffssmi@gmail.com

Dr. Carfagno, D.O. C.A.Q.S.M. is board certified in Sports and Internal Medicine, two doctors in one. 

He founded SSMI sixteen years ago with the philosophy of “Treating YOU Like Family”. 

His innovative approach to care has made him a healthcare leader locally and internationally.  He is a graduate of the world-renowned Cleveland Clinic.

References:            

  1. Feinberg JH. Burners and stingers. Phys Med Rehabil Clin N Am 2000; 11:771
  2. Hershman EB. Injuries to the brachial plexus. In: Athletic Injuries to the Head, Neck, and Face, 2nd ed, Torg JS (Ed), Mosby-Year Book, St. Louis, MO 1991.
  3. Kuhlman, G. (2017). Burners (stingers): Acute brachial plexus injury in the athlete. In AF Eichler (ed.) Uptodate.
  4. Thein L. Rehabilitation in shoulder injuries. In: Rehabilitation Techniques in Sports Medicine, 2nd ed, Prentice WE (Ed), Mosby-Year Book, Inc, St. Louis 1994.
  5. Torg JS, Ramsey-Emrhein JA. Cervical Spine and Brachial Plexus Injuries: Return-to-Play Recommendations. Phys Sportsmed 1997; 25:61.

Image credit:

By Henry Vandyke Carter - Henry Gray (1918) Anatomy of the Human Body (See "Book" section below)Bartleby.com: Gray's Anatomy, Plate 808, Public Domain, https://commons.wikimedia.org/w/index.php?curid=541664