Burners and Stingers (Care of the Young Athlete)

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Burners and stingers are intense pains that
occur when the nerves that run from the neck to the arm are stretched or
compressed. This typically occurs in contact or collision sports where the
shoulder may be pushed backward or the head and neck is forcibly pushed to the
side. Burners are most common in football players but are also common in those
who participate in hockey, wrestling, lacrosse, and diving. The term
burner will be used in this handout to refer to both
burners and stingers.

Symptoms

Athletes who have just sustained a burner will
typically hold their arm limply at their sides or be observed shaking their arm
to get rid of the tingling or burning sensation. A burning or stinging pain runs
from the neck and shoulder down the arm even into the hand. In addition to the
burning pain, it may feel like the arm has fallen asleep or like “pins
and needles.” There may also be weakness in the shoulder and arm. Neck
pain and spasm typically follow an injury that leads to a burner, but pain over
the bones in the neck, pain radiating to both arms, or pain radiating to the
legs suggests a possible spinal cord injury.

Medical evaluation

Athletes with a burner should be evaluated by a
physician and should not return to their sport until they have fully recovered.
A single burner or the effects of recurrent burners can lead to permanent
neurologic damage. Nerves that have been injured are more susceptible to injury.
Testing to evaluate nerve injury and recovery should be done by a trained
medical specialist. Furthermore, burners can easily be confused with other neck
injuries. Athletes who have tenderness over the bones in their neck or symptoms
in both arms or a leg should be stabilized on the playing field and transported
to a facility that can evaluate the athlete for possible spinal cord injury.

Treatment

The main treatment for a burner is rest until
the symptoms completely go away and muscle strength is regained. Most burners
last seconds to minutes. Sometimes the symptoms last hours or days, and athletes
must rest from playing their sport that entire time. Ice to the base of the neck
for at least 20 minutes, 3 or 4 times a day, may be helpful for the first 48 to
72 hours after the injury. Use of nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen or naproxen, may also be helpful. While it is unusual for a
burner to cause permanent nerve damage in young athletes, any athlete with a
burner should be examined by a physician. In addition, they should not be
allowed to return to practice and play until a physician has determined that
they have full sensation, strength, and neck motion.

Some athletes are more prone to burners than
others. Athletes with frequent burners (such as multiple burners in a season or
multiple seasons with a burner) should see a doctor. If symptoms are lasting
longer or are becoming more severe, a longer rest period would be a good idea.
Once the nerves have been injured, generally they are reinjured more easily.

Prevention

The best way to prevent a burner is for athletes
to use proper tackling technique (“see what you hit”) and
strengthen their neck muscles. This will help limit excess motion of the neck
from contact or collisions and reduce either stretch or compression to the
nerves. In football, various collars (neck rolls, cowboy collars) have been
created that can be attached to the shoulder pads to limit neck motion. The
efficacy of these devices in preventing burners is unclear. Athletes who use
these collars must make sure they can still extend their necks and look up
during a tackle. In football, being able to see what you hit generally reduces
the risk of serious injury that can occur when the neck is bent forward at the
time of impact. Burners can also be prevented by avoiding contact or collisions
until the effects of a previous burner have completely resolved.