Stingers

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Burners or stingers are common injuries in American Football. It has been reported that there are 2.2 brachial plexus injuries per 100 players per year. It has been estimated that at the collegiate level approximately 50% of football players have sustained a stinger. Of these, it is estimated that 30% suffered their first injury while playing high school football. The injury is most common with tackling and blocking.

The brachial plexus is formed by the convergence of the fifth through eight cervical and first thoracic nerve roots. The nerve roots combine to form three main trunks. The three trunks branch off and combine to form three cords, which then combine and branch to form the innervation for the upper extremity. The four main nerves at the end of the brachial plexus are the Musculocutaneous, Median, Radial, and Ulnar Nerves. (See Figure 1.)

The mechanism of injury is a downward or backward blow to the ipsilateral shoulder with concomitant neck lateral flexion away from the affected shoulder. This results in an increase in the distance from the acromion of the scapula and mastoid process of the skull, stretching the brachial plexus. Repeat injuries can occur with neck lateral flexion toward the side of injury or hyperextension of the neck. This may be due to scarring and fixation of the brachial plexus to the scalene musculature, or cervical foramen narrowing.

The injury manifests itself with immediate sharp burning or stinging pain radiating from the clavicular area down the arm to the hand. There is an accompanying numbness and tingling of the arm that may last for only a few seconds to several minutes. True neck pain should not be involved with this injury, and if it is present, a cervical spine injury should be suspected.

Weakness may be present at the time of injury, and may last for one to several minutes. This is the familiar “dead arm” that football players appear to have after the injury. The affected musculature consists of: the deltoid, supraspinatus, infraspinatus, biceps, and on rare occasions the brachioradialis, supinator, and pronator teres.

These muscles arise from the upper trunk of the plexus. It has been postulated that the injury is more commonly at the trunk level and not the nerve root level. This is thought to be due to the noninvolvement of the cervical paraspinal muscles, serratus anterior, or rhomboids which are innervated by the Long Thoracic Nerve. The long thoracic branches from C5 and C6 thru C7, prior to the convergence of C5 and C6 to form the upper trunk. Proper evaluation of the affected musculature will help to differentiate between a Brachial Plexus Stretch injury and a more severe nerve root or cervical spine injury.

Continue on to Stinger Classification

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Last Update for AthleticAdvisor.com: 06/04/2006 12:01:52 PM