Burners and stingers
Alerts and Notices
SynopsisBurners and stingers are also known as transient brachial plexopathy or dead arm syndrome. Burners and stingers are upper extremity nerve injuries that commonly affect the C5 and C6 cervical nerve roots or the upper trunk of the brachial plexus.
Causes / typical injury mechanism: The most common mechanism of developing burners or stingers is a traction injury, which is the downward displacement of the shoulder and lateral flexion of the neck to the contralateral side, resulting in traction being applied to the brachial plexus. A second potential mechanism is compression injury, which occurs when the neck is hyperextended and laterally flexed to the ipsilateral shoulder, resulting in compression of the brachial plexus. Compression injuries resulting in a burner or stinger are more common among experienced athletes with preexisting degenerative C-spine changes. Another mechanism is a direct blow injury, which occurs to the supraclavicular fossa at Erb's point; this commonly occurs from the opponent's helmet or shoulder.
Classic history and presentation: Burners are characterized as pain radiating down a unilateral upper extremity in a circumferential, nondermatomal pattern. Numbness, paresthesia, and weakness in the extremity have also been reported. The painful, tingling sensation that patients feel in their unilateral upper extremity resolves spontaneously, typically within a couple of minutes.
The patient reports that, immediately after their injury, they developed a burning sensation in their shoulder and upper extremity, and, since their accident, they have been experiencing these intermittent symptoms.
Prevalence: Burners are very common among contact sports athletes; the true incidence is underreported. There is an incidence of 65% among American college football players, and 70% of them did not report burner symptoms to their health care provider. Their rate of recurrence was 87%.
- Age – Typically 14-22 years.
- Sex / gender – Male.
S14.3XXA – Injury of brachial plexus, initial encounter
6836001 – Injury of brachial plexus
Differential Diagnosis & Pitfalls
- Cervical spine fracture
- Cervical spine facet dislocation
- Spinal cord contusion
- Central cord syndrome
- Cervical disk herniation with nerve root impingement
- Shoulder muscle strain
- Arm muscle strain
- Clavicle fracture
- Neck muscle strain (whiplash)
- Brachial plexitis or brachial neuritis (Parsonage-Turner syndrome)
- Shoulder subluxation
- Shoulder dislocation (anterior or posterior)
- Acromioclavicular sprain
- Thoracic outlet syndrome
- Scapula fracture
- Brachial plexus avulsion (see brachial plexus injury)
- Floating shoulder
Burners and stingers