Review Question - QID 1204

Patients with stingers (burners) have unilateral symptoms exclusive to the upper extremity. Any evidence of bilateral upper extremity or lower extremity symptoms should be evaluated for spinal cord injury. A burner is often associated with contact sports. This injury is thought to be a transient neuropraxia caused by injury to the brachial plexus or a cervical root as a result of traction, compression or a direct blow.

The patient typically reports a sharp burning on the involved side that may radiate into the shoulder and down the arm to the hand. Weakness and paresthesia in the involved extremity lasting several seconds to several minutes may accompany the injury. Along with these short lived symptoms, there should be full, pain-free range of neck motion. Athletes can return to play after resolution of symptoms and restoration of normal strength, and most importantly, if full, pain-free ROM of neck is maintained.

Formal workup is required if neurologic findings are present, symptoms persist, or if there is a history of previous brachial plexus injury. There is documented increased risk with cervical canal and foraminal stenosis and these should be worked up in athletes with recurrent burners. Work up includes EMG, radiographs and MRI. EMG should be delayed 3-4 weeks from the time of the injury.

Koffler reviews neurovascular injuries to consider in athletes.

The Clancy article is one of the original descriptions of this injury in college football players.

Aval et al present a 2-part review of neurovascular injuries in athletes with a discussion of thoracic outlet syndrome, axillary artery occlusion, effort thrombosis, suprascapular nerve entrapment, quadrilateral space syndrome, complex regional pain syndrome, cervical radiculitis, spinal accessory nerve injury, long thoracic nerve palsy, burner (stinger) syndrome, and brachial neuritis.

Illustration A is a diagram presenting an algorithm for brachial plexus evaluation.