Stingers, Burners, and Pinched Nerves, oh my!!!

A “stinger”, “burner”, or “pinched nerve” as they are often referred to sound innocent enough however these are the most common of all cervical neurological injuries and should be taken seriously. Brachial Plexus Neurapraxia is the disruption of normal nerve function without the nerve itself being degenerated. The etiology of this injury results from a stretching or compression of the brachial plexus. The brachial plexus is the network of nerves formed by the cervical and thoracic spinal nerves and supplies the arm and parts of the shoulder with movements and sensations. It is located behind the collar bone and goes down both sides of the neck. The primary mechanism of injury is stretching of the brachial plexus when the neck is forced laterally to the opposite side while the shoulder is depressed. A perfect example of this would be a shoulder block in football. A second mechanism compresses the brachial plexus when the neck is extended, compressed, and rotated toward the affected side.

This injury can become more severe if there is direct trauma to the brachial plexus itself with a compressing force. There is usually severe tenderness over the trapezius. This injury can result in a partial rupture of the nerve without complete rupture which is called axontomesis. When this happens the protective myelin sheath is damaged that surrounds the nerve. In this case the nerve can and will eventually heal itself. However in some cases, a nerve can be completely torn off. When this happens, there is no potential for recovery unless surgical reconnection is made in a timely manner which makes this a medical emergency.

The athlete with a stinger or burner will complain of pain and numbness radiating into all fingers of the hand. If there is no weakness in the surrounding muscles of the shoulders, arms, and hands the athlete can return to play when all symptoms are gone. The athlete will complain of a burning sensation, numbness and tingling, and pain extending from the shoulder down to the hand with some loss of function that can last several minutes and in rare cases, several days. However repeated brachial plexus injuries can result in neuritis, muscular atrophy (muscle shrinking), and permanent damage which is why this is injury should be closely documented and monitored especially is those high impact sports.

Once all of the symptoms have completely resolved and there are no associated neurological symptoms, the athlete may return to full activity. Some rehabilitation techniques should be strengthening and stretching exercises for the neck muscles.

For more information please visit the sites below:  http://www.ninds.nih.gov

(National Institute of Neurological Disorders and Stroke)

http://www.ubpn.org

(United Brachial Plexus Network, inc)

http://www.aafp.org/afp/20001101/2067.html

(American Academy of Family Physicians)

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