Cervical Sports Injuries: The Stinger

Peer Reviewed

In the world of contact sports, such as football, hockey, or basketball, a common injury is the stinger. A stinger, sometimes called a burner, is an injury that occurs when the head or neck (cervical spine) is hit to one side, causing the shoulder to be pulled in the opposite direction. While stingers occur most often at the high school level, they can occur at all levels of play.
The brain ion cross section showing the major structures including the spinal cord.As a result of a forcible sideways blow to the head or a blow to the shoulder itself, brachial plexus nerves may become compressed, stretched, and irritated.How does a stinger happen?
A stinger is caused by a stretching of the brachial plexus nerves. These are peripheral nerves that exit the spinal cord and run across the shoulders, under the collarbone, and into the arms. The brachial plexus nerves are responsible for giving the arms their strength and sensation. As a result of a forcible sideways blow to the head or a blow to the shoulder itself, these nerves may become compressed, stretched, and irritated.

What are the symptoms of a stinger?
A side collision of this type causes immediate and intense pain, as well as a tingling or burning sensation in the neck that runs down the arm to the fingers. Weakness in the affected arm or hand is also common. The weakness, numbness, or tingling sensations may last as briefly as a few minutes or as long as a few weeks.

How is a stinger treated?
Most stinger injuries resolve on their own with rest. Athletes are usually removed from the sport until symptoms are gone. Ice packs on the neck or shoulders, anti-inflammatory medications, massage, and neck strengthening exercises are often part of the treatment plan. Players can usually return to their sport once the pain is gone and they have regained full range of motion, strength, and normal sensation in the neck and arms. Persistent or recurrent symptoms may indicate a more serious injury. Neck x-rays, a CT scan, or MRI may be necessary to rule out other serious conditions with similar symptoms.

How can a stinger be prevented?
Strengthening neck muscles are an important way for athletes to prevent stingers. Using good technique in contact sports and avoiding spearing (head down tackling) is also important. Safety equipment, such as neck rolls that limit backward movement of the neck, may also help.

Most importantly, players who experience symptoms of a stinger should immediately report them to their coaches or team physician, despite the risk of being removed from the game. Ignoring or playing through a stinger can lead to more serious injuries.

Commentary by Todd J Albert, MD

Dr. Subach's article is important, timely, and accurate. With the start of organized football practice right around the corner, awareness of this entity is most important.The differential entity of radicular pain/weakness should only be entertained if the player's complaints are monoradicular. Otherwise, this global transient weakness is almost always a stinger. Congratulations to Dr. Subach on an excellent and concise review.

Updated on: 07/17/18
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Todd J. Albert, MD
Surgeon in Chief and Medical Director
Hospital for Special Surgery
Weill Cornell Medical College
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