By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
And Tim McAdams, M.D.
Head Team Physician and Medical Director, San Francisco 49ers
Associate Professor of Orthopedic Surgery, Stanford University
• Stingers are common in youth football. The player will feel a burning or stinging sensation from the shoulder to the hand
• The player can return to play with a completely normal arm: no stinging or burning, full motion, normal strength
• Practicing Heads Up Tackling is a good way to minimize your risk of stingers, neck injury, or concussion
As football season rolls along we are seeing a fair number of injuries called “stingers”, also known as “burners”. The injury is named for the stinging or burning pain that spreads from the shoulder to the hand. This can feel like an electric shock down the arm. Stingers are fairly common injuries in collision sport athletes, and fortunately most of these injuries are temporary with rapid return to normal function. A stinger occurs when there is an injury to the network of nerves surrounding the neck and traveling to the shoulder, arm, and hand. In football we commonly see stingers when the neck is stretched to the side during a tackle. We will also see stingers occasionally when the side of the player’s head makes contact with the ground.
Symptoms include neck pain, numbness, burning, or weakness in one arm. In the classic stinger there will be no neck pain. If neck pain accompanies the burning sensation in a young athlete, we would consider that a potential spine injury and would strongly recommend that the player be transported from the field of play to the local emergency department by qualified emergency medical personnel. When neck pain is present, the player should not be moved from the field of play until emergency medical personnel arrive. Keep the helmet and shoulder pads on, and do not move the young athlete.
In the typical stinger the player will often be seen jogging off the field while shaking or wringing his arm to try and get the feeling back into it. Symptoms of the stinger usually get back to normal within minutes, but can sometimes take longer.
The player with a suspected stinger should be observed on the sideline and not return to play until the symptoms are completely back to normal. This means he should have no arm or shoulder pain, his sensation is normal, shoulder motion is normal, and arm strength is normal. A player who returns with some symptoms is not able to adequately protect himself in another collision, and risks making the injury much worse.
In rare cases, stingers can recur or become chronic. In these cases it’s very important to have a thorough evaluation from an orthopedic surgeon or spine specialist. Recurring stingers can indicate an underlying problem such as a narrow spinal canal or disc injury.
Protective equipment can be used to help limit neck motion in a player who’s had a stinger. This can be a cowboy collar or neck roll worn above the shoulder pads.
In terms of preventing a stinger, the best advice we can give is to practice proper Heads Up Tackling. Even perfect technique will not completely eliminate the risk of a stinger, but it can go a very long way towards reducing the risk of stingers, serious neck injury, or concussion. Another factor sometimes overlooked is to play on a team of similarly size-matched players. In high school the problem we see is smaller freshman players suiting up against larger, faster, older players. The freshman is often at a significant physical mismatch against these bigger players and that can be a recipe for injury.