Burner Syndrome

What is it?

Burner syndrome, also known as stingers, is a stretch or compression injury to the brachial plexus. The brachial plexus is a complex of nerves in the lower neck and shoulder area.

Burners are common in contact sports such as football, wrestling, and hockey. For example, 65% of college football players claim to have experienced burner syndrome at some point in their career. However, 70% of the these players said that they did not report their burners.

What are the symptoms?

Burner syndrome is characterized by an immediate, severe, burning pain and prickly paresthesia that radiates from the neck, extending circumferentially to the arm or fingers.

Additionally, symptoms often include numbness and brief paralysis of the arm. Pain, paresthesia, and numbness usually subside within minutes; however, shoulder weakness and muscle tenderness of the neck may be experienced hours or days after the injury.

Clinical examination will commonly reveal weakness in the muscles innervated by the upper trunk of the plexus: the supraspinatus, deltoid, and biceps muscles.

If you experience these symptoms, you should seek medical attention. X-rays are often useful in ruling out additional injuries of the cervical spine. If symptoms do not subside in 2-3 weeks, electrodiagnostic studies should be performed (EMG) to help determine the severity of the injury.

How does the injury happen?

The most common mechanism of injury is the stretching of the brachial plexus from a blow to the head or shoulder. A football tackle can force the shoulder and clavicle downward, which forces the neck into extension on the same side and flexion on the other side (figure, (a)).

This action causes a traction injury to the upper trunk of the brachial plexus.

Compression of the nerves is also possible. A direct blow to the area above the clavicle may force the edge of the shoulder pad into the side of the neck. Another mechanism of injury is cause sidebending (ear to shoulder) with rotation and extension of the cervical spine away from the blow. This leads to the compression of the brachial plexus (b).

What is the treatment for stingers?

Generally, athletes should not be involved in competition if they are experiencing the symptoms of stingers. Within 48 hours of the injury, the athlete should adhere to the PRICE principle:

  • P: Protect the injured body part (e.g.: sling)
  • R: Rest the involved shoulder and arm
  • I: Ice the neck and shoulder muscles to relieve pain and control muscle spasm
  • C: Compression using an elastic bandage wrap may be useful if there is swelling
  • E: Elevation of the arm or shoulder may help decrease swelling

A few days after injury, the athlete should try to maintain cardiovascular fitness while limiting the use of the arms or shoulders (e.g., riding a stationery bicycle).

Additionally, active assisted exercise of the neck and shoulder can be performed.

Cervical isometric exercises in flexion, extension, sidebending, and rotation are simple exercises to increase strength in the neck muscles (figure 4, below).

Progressive resistive exercises are beneficial for the rotator cuff muscles (internal/external rotation and abduction).

Finally, muscles surrounding other joints such as the elbow and wrist should not be ignored.

When can I return to play?

For athletes with burners or stingers, the return to play criteria are as follows:

  • Resolved neck pain, arm pain, and dysesthesia
  • Pain-free, full range of motion of the neck
  • Pain-free, full range of motion of upper extremity
  • Normal strength on manual muscle testing compared with preseason measurements
  • Normal deep tendon reflexes
  • Negative Spurling test (a test for cervical nerve root involvement)

What can I do to avoid it?

Preventing burners is as important as the proper treatment of burners. It was shown in a research study that 57% of the athletes with burners experienced more than one injury.

The following preventive measures will help decrease the chances of a burner injury:

  • Always wear protective gear that fits properly. The  Cowboy Collar (McDavid Knee Guard, Inc, Chicago), which has been found to be better than neck rolls and is used by professional football players, is recommended.
  • Proper blocking and tackling technique. Poor technique can predispose one to experiencing a burner. Ask a coach to observe your technique.
  • Maintain good strength in the upper extremities with the following exercises: