Cervical Stingers and Burners: Brachial Plexus Traction in Contact Sports
In short
A stinger produces immediate electric shooting shock down one arm; unilateral transient weakness differentiates benign neuropraxia from cervical cord emergencies.
In this guide (4 sections)
Pathophysiology of the Athletic 'Stinger' or 'Burner'
A cervical stinger (also known as a burner) is a transient neurological injury of the upper extremity common in collision sports such as rugby, American football, ice hockey, wrestling, and kabaddi. Athletes experience an immediate, intense shock of burning pain, numbness, and tingling shooting from the neck down one arm into the hand, accompanied by temporary arm weakness (the 'dead arm').
Pathophysiologically, a stinger is an acute Grade I neuropraxia involving the upper trunk of the brachial plexus (C5 and C6 nerve roots). It arises from two primary mechanical mechanisms: traction trauma (lateral flexion of the head away from the affected shoulder while the shoulder is depressed) or compressive nerve root pinch (lateral flexion and hyperextension of the head toward the affected side, closing the neural foramen).
Diagnostic Differential: Stinger vs Cervical Spine Emergency
| Clinical Feature | Transient Stinger / Burner (Neuropraxia) | Cervical Cord Neuropraxia (Medical Emergency) | Cervical Spine Fracture / Subluxation | |
|---|---|---|---|---|
| Laterality of Symptoms | Strictly UNILATERAL (one arm only) | BILATERAL (both arms, or arms and legs) | Bilateral numbness, quadriplegia, or spinal shock | |
| Duration of Paresthesias | Minutes (typically resolves in < 15 minutes) | Hours to days (transient quadriplegia) | Persistent neurological deficit | |
| Neck Pain / Midline Tenderness | Minimal neck pain; pain is in the shoulder/arm | Moderate neck ache without bony deformity | Severe focal midline tenderness, palpable step-off, spasm | |
| Emergency Management | Remove from play; sideline neurological exam | Immediate spine board immobilization; call 911 | Spine board immobilization; emergency CT scan mandatory |
Sideline Return-to-Play Criteria for Stingers
- The Four Mandatory Sideline Criteria: An athlete may return to the same game ONLY if: (1) all burning/tingling has 100% resolved; (2) neck range of motion is completely full and pain-free; (3) deltoid, biceps, and wrist extensor strength is grade 5/5; (4) Spurling test is negative.
- The Rule of Recurrence: If an athlete sustains a second stinger in the same game, they must be permanently removed from contact for the day and undergo formal MRI cervical spine evaluation.
- Equipment Modifications (Cowboy Collars): Equip collision athletes with an elevated neck roll, cowboy collar, or butterfly restraint; these devices physically block extreme lateral neck flexion, preventing traction on the brachial plexus.
Frequently Asked Questions
What does a stinger feel like in contact sports?
A stinger feels like an electric shock or intense burning sensation that shoots from your neck down your arm into your fingers, followed by your arm feeling completely limp and useless for a few minutes.
How do you know if a stinger is actually a dangerous neck fracture?
A stinger affects ONLY ONE ARM and completely goes away in a few minutes. If numbness, tingling, or weakness affects BOTH arms or any leg, or if you have severe tenderness in the center of your neck, it is a medical emergency requiring an ambulance.
What is a 'cowboy collar' in sports?
A cowboy collar is a stiff foam brace that attaches to an athlete's shoulder pads behind the helmet. It acts as a mechanical stopper, preventing the head from snapping violently backward or sideways, which stops the nerves from being stretched.
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