The Burner/Stinger Football Injury Symptoms and Treatment

A burner, also called a stinger, is a common injury in contact sports, especially football. Burners in football participants are extremely common, with over 50% of all athletes reporting at least one burner over the span of their career—and some with repeated episodes.

Burner: What Is Happening?

A burner is thought to be due to stretch and/or compression of the brachial plexus. The brachial plexus is a network of nerves that's located just outside the spinal cord at the neck. These nerves branch out and travel across the shoulder and into the arm.

Any type of nerve disruption can cause pain, numbness, and/or weakness. 

During a burner injury, an athlete's neck may be stretched away from the affected shoulder, such as during a collision or fall to the ground. When the upper shoulder area strikes the ground forcefully, the head and neck can pull to one side, while the shoulder is pushed to the other.

The resulting stretch on the shoulder and neck may cause an injury to the brachial plexus.

Burner Symptoms

Symptoms of a burner include sudden pain and tingling, extending from the neck, and running down the arm into the fingers. This injury is known as a burner because it is characterized by a warm, burning sensation extending down the arm.

Typically, the painful symptoms resolve within a few minutes or hours.

Often athletes who sustain a burner have weakness of the affected arm. Weakness may take several hours to develop and it may take days, weeks—or even longer—for weakness to resolve.

Athletes who sustain a burner should be immediately evaluated by a clinician who is trained in diagnosing these injuries. The evaluation should include testing of sensory abnormalities and muscle weakness. Any athlete with findings of numbness or weakness should not return to participation until symptoms have completely resolved.

Treatment of a Burner

There is little that can be done to treat a burner, although some therapeutic activity including light stretching and strengthening may be helpful. In order to return to sports, athletes having sustained a burner should have achieved the following criteria:

1. Normal range-of-motion of the neck and arm
2. Resolution of abnormal sensations (paresthesias)
3. Normal diagnostic tests, including Spurling's test
4. Normal strength testing

Efforts at preventing burners are geared toward strengthening the neck and shoulder muscles.

In addition, some football players will use special pads or collars ("cowboy collars") to minimize excessive stretch of the brachial plexus to prevent recurrent stinger injuries.

Warning Signs

Athletes who have symptoms that are not typical of a burner or who have unresolved symptoms should have an evaluation to determine if there is another cause of their symptoms. Several conditions that affect the neck and spinal cord can mimic symptoms of a burner, and these need to be considered in athletes with severe or persistent symptoms.

Further testing can evaluate for other possible causes of numbness and weakness, such as a herniated disc or spinal nerve injury. Tests may include x-rays, MRIs, or nerve conduction studies.