115:. The brachial plexus is formed by the anterior rami of the nerves at the 5th cervical level of the spinal cord all the way to the nerves at the 1st thoracic level of the spinal cord. The brachial plexus innervates the upper extremity as well as some muscles in the neck and shoulder. Damage to the brachial plexus can occur when the nerves are stretched too far from the head and neck; specifically the upper trunk of the plexus – nerve roots at the 5th and 6th cervical level – are primarily affected. The upper trunk provides part of the nerve to supply to the upper extremity via the Musculocutaneous, Axillary, Radial and Median nerves. It is for this reason that stingers do not affect both arms simultaneously, however it is possible for both arms to accrue injuries. Repeated nerve
217:
Returning from this injury depends on the number of burners that occurs. If a stinger occurs, the athletes usually return to play after they restore full strength, are asymptomatic where no pain persists, and painless range of motion in the cervical spine. At low frequencies of stingers, like 1 or 2,
277:
The following study found different frequencies in the number of stingers that occur. Incidence of stingers over a six-year study period with only 1.5 stingers per team each season. Most of the stingers reported were either during competitions or preseason. Exactly 93% of stingers were due to player
233:
Flexibility and strength of the neck, shoulder, and upper extremity are essential because stiffness and weakness are predisposing factors for a burner as well as consequences of this injury. Factors that could help in the prevention of stingers could include strengthening the muscles, increasing the
290:
in the sport due to the risk of injury. When a player makes head-down contact, that player has much more of a chance of a significant spinal cord injury. After the initial rule change, many of the cervical spine injuries stopped. Therefore, this prompted a new tackling technique to be adopted, such
178:
by a medical professional. This person will assess the athlete's pain, range of head and neck motion, arm numbness, and muscle strength. Often, the affected athlete is allowed to return to play within a short time, but persistent symptoms will result in removal. Athletes are also advised to receive
273:
Stingers commonly occur in contact sports like wrestling, hockey, basketball, boxing, rugby, weightlifting, and, most notably, football. One study found that up to 65% of college football players have suffered at least one stinger. However, it is difficult to ping an exact number of athletes that
237:
Simple measures can be taken to help in the recovery from stingers. A chest-out posture should be adapted to prevent the neck from extending too far because it brings the head over the shoulders. The chest-out posture is emphasized due to it not being commonly adopted by athletes due to developed
229:
Stingers can be prevented by several of the following factors, but first, it is crucial to identify the severity of the stinger because treatment usually depends on that factor. If strengthening treatment starts too early with a severe case, it can prevent one from healing. The dysfunctions that
80:
that travels down one arm, followed by numbness and weakness in the parts of the arms, including the biceps, deltoid, and spinati muscles. Many athletes in contact sports have suffered stingers, but they are often unreported to medical professionals.
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as the head-up tackling technique. This technique does prevent catastrophic spine injuries, but it can result in brachial plexus injuries. After the rule change, it has been estimated that stingers have gone up in prevalence.
107:
The three main mechanisms of a stinger include receiving direct blows, extension, and compression of the brachial plexus, with most of the brachial plexus injuries being an extension-compression mechanism.
146:, with the axon and the connective tissue sheath remaining intact. The disruption of nerve function involves demyelination. Axonal integrity is preserved, and remyelination occurs within days or weeks.
257:, designed to protect the head and neck from being forced into unnatural positions. This equipment is more feasible in positions where unrestricted head and neck movement is not required, such as
221:
If one is returning from play to contact sports it is important to adopt a strict exercise regimen of the neck muscles so the player has the ability to handle the trauma associated with tackles.
702:
Green, James; Zuckerman, Scott L.; Dalton, Sara L.; Djoko, Aristarque; Folger, Dustin; Kerr, Zachary Y. (2017-01-02). "A 6-year surveillance study of "Stingers" in NCAA American
Football".
265:, where such movement is integral. Regardless of equipment, it is important to report even minor symptoms to an athletic trainer or team physician, and to allow appropriate recovery time.
802:
Chao, Simon; Pacella, Marisa J.; Torg, Joseph S. (2010-01-01). "The
Pathomechanics, Pathophysiology and Prevention of Cervical Spinal Cord and Brachial Plexus Injuries in Athletics".
526:
Chao, Simon; Pacella, Marisa J.; Torg, Joseph S. (2010-01-01). "The
Pathomechanics, Pathophysiology and Prevention of Cervical Spinal Cord and Brachial Plexus Injuries in Athletics".
394:
PM&R Knowledge. "AAPM&R - American
Academy of Physical Medicine and Rehabilitation." PM&R Knowledge NOW. American Academy of Physical Medicine and Rehabilitation, 2012.
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where there is a complete disruption of the axon, where it is unlikely of recovery. If this is to happen it is not considered a stinger, and usually is a high-energy injury to the
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suffer from stingers as stingers are historically under-reported. This could be due to the players fear of being removed from play or the injury being viewed as unimportant.
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regular evaluations until symptoms have ceased, specifically, the restoration of pain-free mobility. If they have not after two weeks, or increase, additional tests such as
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there is a much lower risk of the symptoms reoccurring. If three or more stingers occur in one season, one has a higher increased risk at the symptoms persisting.
254:
130:
Since stingers are a nerve injury, a stinger can fall into two different categories of peripheral nerve injury with physiological differences.
579:"ASSESSMENT AND REHABILITATION OF THE ATHLETE WITH A "STINGER": A Model for the Management of Noncatastrophic Athletic Cervical Spine Injury"
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The order of treatments applied depends on whether the athlete's main complaint is pain or weakness. Both can be treated with an
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Anyone who experiences significant trauma to his or her head or neck needs immediate medical evaluation for the possibility of a
368:
690:
385:
Saladin, Kenneth S. Anatomy & Physiology: The Unity of Form and
Function. 6th ed. New York, NY: McGraw-Hill, 2012. Print.
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Numbness or paralysis may develop immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord
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The time between injury and treatment can be critical in determining the extent of complications and the amount of recovery
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Weinberg , J., Rokito , S., & Silber , J. S. (2003). Etiology, treatment, and prevention of athletic ‘‘stingers.’’
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A serious spinal injury is not always immediately obvious. If it is not recognized, more severe injury may occur
755:"National Athletic Trainers' Association Position Statement: Head-Down Contact and Spearing in Tackle Football"
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which is the most severe case of nerve injury in the context of stingers and involves the injury of the axon.
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88:. In fact, it is safest to assume that trauma victims have a spinal injury until proven otherwise because:
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856:
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A stinger is an injury that is caused by restriction of the nerve supply to the upper extremity via the
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Heck, Jonathan F.; Clarke, Kenneth S.; Peterson, Thomas R.; Torg, Joseph S.; Weis, Michael P. (2004).
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http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.624.6013&rep=rep1&type=pdf
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caused the peripheral nerve injury must be identified to treat and prevent future injury.
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contact, specifically 36.7% occurring while tackling and 25.8% occurring while blocking.
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Finally, stingers can be prevented by wearing protective gear, such as
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In 1976 most major
American football leagues banned the technique of
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weakness, while recovery can take weeks to months in severe cases.
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183:(MRI) can be performed to detect a more serious injury, such as a
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440:"Peripheral Nerve Entrapment and Injury in the Upper Extremity"
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irritation. The chest-out posture also reduces pressure on the
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Kuhlman, Geoffrey S.; McKeag, Douglas B. (1 November 1999).
201:, ice and heat, restriction of movement, and if necessary,
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626:"The "Burner": A Common Nerve Injury in Contact Sports"
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Kuhlman, Geoffrey S.; Mckeag, Douglas B. (1999-11-01).
466:"The "Burner": A Common Nerve Injury in Contact Sports"
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Kuhlman, Geoffrey S.; Mckeag, Douglas B. (1999-11-01).
406:"The "Burner": A Common Nerve Injury in Contact Sports"
331:"The "Burner": A Common Nerve Injury in Contact Sports"
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McKeag, Douglas B.; Kuhlman, Geoffrey S. (1999-11-01).
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range of motion, and improving technique when playing.
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Qureshi, Sheeraz A.; Hecht, Andrew C. (2010-12-01).
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Qureshi, Sheeraz A.; Hecht, Andrew C. (2010-12-01).
76:injury is characterized by a shooting or stinging
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649:"Burner Syndrome and Cervical Cord Neuropraxia"
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489:"Burner Syndrome and Cervical Cord Neuropraxia"
655:. Athletic Spine Injuries: State of the Art.
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495:. Athletic Spine Injuries: State of the Art.
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438:Neal, Sara L.; Fields, Karl B. (2010-01-15).
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209:is only necessary in the most severe cases.
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369:"Spinal cord injury - Symptoms and causes"
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309:"Burners and Stingers - OrthoInfo - AAOS"
16:Neurological injury sustained by athletes
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138:, which involves focal damage of the
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577:Weinstein, Stuart M. (1998-01-01).
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689:, 493–500. Retrieved from
687:CLINICS IN SPORTS MEDICINE
583:Clinics in Sports Medicine
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181:magnetic resonance imaging
653:Seminars in Spine Surgery
630:American Family Physician
493:Seminars in Spine Surgery
470:American Family Physician
444:American Family Physician
410:American Family Physician
335:American Family Physician
261:, than in positions like
259:American football lineman
170:Diagnosis and treatment
255:butterfly restrictors
341:(7): 2035–40, 2042.
174:Stingers are best
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36:pinch injury
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263:quarterback
160:neurotmesis
152:axonotmesis
142:around the
136:neurapraxia
295:References
225:Prevention
199:medication
58:ice hockey
861:spine.org
824:1179-2035
771:1062-6050
740:205890230
724:1543-8627
673:1040-7383
603:0278-5919
548:1179-2035
513:1040-7383
347:1532-0650
192:analgesic
176:diagnosed
156:Grade III
103:Mechanism
70:wrestling
879:Category
840:38536297
832:20020787
789:15085218
732:27873542
564:38536297
556:20020787
422:10569506
355:10569506
313:aaos.org
288:spearing
148:Grade II
56:such as
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29:burner
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836:S2CID
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74:spine
62:rugby
34:nerve
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820:ISSN
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418:PMID
351:PMID
343:ISSN
144:axon
78:pain
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