Burners and Stingers

with Rehab

Injury to the arm and shoulder (brachial plexus) nerves often causes pain and weakness in the shoulder known as a burner or stinger. Many sports injuries from a tackle, fall, or direct trauma to the shoulder will cause these nerves to become stretched and damaged. These types of injuries result in variable patterns of pain, weakness, or tingling in the shoulder, arm, or hand. The pain or weakness may last for variable lengths of time depending on the severity of injury (seconds to weeks or longer).

SYMPTOMS

  • Sudden intense burning or stinging pain from the side of the neck into the shoulder, arm, or hand and fingers at the time of injury.

  • Pain and discomfort (burning or dull ache) that is poorly localized.

  • Heaviness or fatigue of the shoulder, arm, or hand.

  • Decrease in function of the shoulder, arm, elbow or hand.

  • Numbness, tingling, or pins and needles sensation around the shoulder, arm or hand.

CAUSES

Burners and stingers are caused by injury to the nerves of the brachial plexus from direct trauma like a tackle or a fall.

RISK INCREASES WITH:

  • Contact sports.

  • Ill-fitting shoulder pads.

  • Previous burner or stinger.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded shoulder pads.

PROGNOSIS

Most stingers and burners have a spontaneous resolution without treatment. Up to 10% of burners may cause symptoms that persist for a longer period of time.

RELATED COMPLICATIONS

  • Permanent weakness of the shoulder, arm or hand.

  • Persistent pain in the shoulder, arm or hand.

  • Stiffness of the shoulder, arm or hand.

  • Persistent numbness of the shoulder, arm or hand.

  • Disability and inability to compete in athletic events.

  • Increased susceptibility to recurrent nerve injury (burners and stingers) and permanent nerve injury.

TREATMENT

Treatment initially requires rest from the activity that caused the nerve damage. Nonsteroidal anti-inflammatory drugs will help reduce pain. The nerves spontaneously recover, however, this may take as little as a few seconds or as long as 6 months. It is very important to maintain shoulder strength and a full range of motion while symptoms persist. In order to do this you may be referred to a therapist to complete a regimen of exercises. Returning to sport before the injury resolves will increase your chances of experiencing future stingers or burners. Surgery is rarely necessary.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

Heat and cold therapy have not been proven to affect the course of this problem.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks despite treatment.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION(ROM) AND STRETCHING EXERCISES - Burners/Stingers

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 20 seconds, although you may need to begin with shorter hold times for comfort.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

STRETCH- Axial Extensors

  • Lie on your back on the floor. You may bend your knees for comfort. Place a rolled up hand or dish towel, about 2 inches in diameter, under the part of your head that makes contact with the floor.

  • Gently, tuck your chin, as if trying to make a "double chin," until you feel a gentle stretch at the base of your head.

  • Hold __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRETECH - Axial Extension

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Slowly retract your chin so your head slides back and your chin slightly lowers. Continue to look straight ahead.

  • You should feel a gentle stretch in the back of your head. Be certain not to feel an aggressive stretch since this can cause headaches later.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Cervical Side Bend

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Without letting your nose or shoulders move, slowly tip your right / left ear to your shoulder until your feel a gentle stretch in the muscles on the opposite side of your neck.

  • Hold __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

STRETCH – Cervical Rotators

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Keeping your eyes level with the ground, slowly turn your head until you feel a gentle stretch along the back and opposite side of your neck.

  • Hold __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

RANGE OF MOTION - Neck Circles

  • Stand or sit on a firm surface. Assume a good posture: chest up, shoulders drawn back, abdominal muscles slightly tense, knees unlocked (if standing) and feet hip width apart.

  • Gently roll your head down and around from the back of one shoulder to the back of the other. The motion should never be forced or painful.

  • Repeat the motion 10-20 times or until you feel the neck muscles relax and loosen.

Repeat __________ times. Complete the exercise __________ times per day.

STRENGTHENING EXERCISES - Burners/ Stingers

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

STRENGTH – Cervical Flexors, Isometric

  • Face a wall, standing about 6 inches away. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between your forehead and the wall.

  • Slightly tuck your chin and gently push your forehead into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.

  • Hold 10 to 20 seconds. Keep your breathing relaxed.

  • Release the tension slowly. Relax your neck muscles completely before you the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH- Cervical Lateral Flexors, Isometric

  • Stand about 6 inches away from a wall. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between the side of your head and the wall.

  • Slightly tuck your chin and gently tilt your head into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.

  • Hold 10 to 20 seconds. Keep your breathing relaxed.

  • Release the tension slowly. Relax your neck muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH – Cervical Extensors, Isometric

  • Stand about 6 inches away from a wall. Place a small pillow, a ball about 6-8 inches in diameter, or a folded towel between the back of your head and the wall.

  • Slightly tuck your chin and gently tilt your head back into the soft object. Push only with mild to moderate intensity, building up tension gradually. Keep your jaw and forehead relaxed.

  • Hold 10 to 20 seconds. Keep your breathing relaxed.

  • Release the tension slowly. Relax your neck muscles completely before you start the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.