Transient Brachial Plexopathy (Stingers/Burners)

Abstract

Transient brachial plexopathies, also referred to as “stingers” and “burners,” are common athletic injuries, especially in collision athletes. There are multiple proposed etiologies of stingers, with trauma to the upper brachial plexus or cervical nerve roots being the most important causative factor. Athletes with a stinger typically present with unilateral weakness or inability to move the involved upper extremity after a forceful collision. Along with upper extremity weakness, the athlete often experiences intense ipsilateral paresthesias or “burning pain,” consistent with the name of “stinger” or “burner.” Management of a stinger is often supportive with minimal intervention required. Imaging of the cervical spine is recommended when symptoms persist for longer than 1 h or in the setting of a recurrent stinger. Return to play decisions are influenced by the athlete’s clinical examination, history of previous stingers, or other concomitant neurological injuries. Clearing an athlete for competition after numerous stingers can be controversial, and this decision is influenced by multiple factors, including severity of symptoms, number of previous stingers, and degree of cervical spine stenosis.