Overview
A stinger, or burner, is a stretch or compression injury to the brachial plexus, the bundle of nerves that runs from the neck through the base of the shoulder into the arm. It happens when the head is driven one way and the shoulder the other, or when the neck is bent hard to one side, pinching the nerve roots. The result is a burst of burning pain and weakness down one arm that usually fades within minutes. It is the most common nerve injury in football and also occurs in rugby, wrestling and skiing falls.
Two things decide management: whether this episode has cleared completely, and whether it is the first. A single stinger with full strength and sensation back within minutes allows a return to play the same day. Symptoms that persist, involve both arms, or recur across a season raise the question of a cervical disc, a narrow spinal canal, or a nerve that has not recovered. Dr. O'Donnell manages stingers non-operatively and refers to a spine surgeon when imaging shows canal stenosis or cord signal change, or when weakness persists.
Common Symptoms
- Sudden burning, stinging or electric pain from the neck or shoulder down one arm to the hand, immediately after a hit
- Temporary weakness of the shoulder and arm: trouble lifting the arm out to the side, bending the elbow or gripping
- Numbness or tingling in the arm, not confined to a single finger pattern
- Symptoms resolving within seconds to minutes; occasionally weakness that lingers for hours or days
Symptoms in both arms, in the legs, or with neck pain and limited neck motion are not a stinger until proven otherwise; they are treated as a cervical spine injury on the field. Arm pain that persists for days with tingling in specific fingers suggests a cervical disc herniation; neck pain and stiffness without arm symptoms is a neck strain.
Causes & Risk Factors
Three mechanisms: the head and shoulder pulled apart in a tackle, stretching the plexus; the neck extended and compressed toward the side of the injury, pinching the nerve roots where they exit; and a direct blow above the collarbone. Poor tackling technique with the head down, ill-fitting shoulder pads, weak neck and scapular muscles, and a congenitally narrow cervical canal all raise the risk, and a previous stinger is the strongest predictor of the next.
How It Is Diagnosed
On the sideline Dr. O'Donnell checks for neck pain and midline tenderness first, then full cervical range of motion, the Spurling test, and strength in the deltoid, biceps, external rotators and grip compared with the other arm, plus sensation and reflexes. A player returns to the game only if all of that is normal, the symptoms lasted minutes not hours, it is the first episode of the season, and the neck moves fully without pain. In the office the same exam is repeated, with attention to the shoulder, because a dislocation or AC joint injury can be missed alongside a stinger.
A first stinger that clears does not need imaging. X-rays with flexion-extension views are ordered for persistent neck pain or a second episode, and MRI is ordered for symptoms lasting more than a few days, for weakness that persists, for any episode with bilateral or leg symptoms, and for recurrent stingers, because it shows disc herniation, foraminal narrowing and the width of the spinal canal. An EMG at 3 weeks or more grades the nerve injury when weakness has not recovered. Athletes elsewhere can send imaging through mymedicalimages.com.
Treatment Options
Non-operative care
The nerve recovers on its own; treatment is about protecting it and preventing the next one. A player with any residual weakness or numbness sits out until the exam is normal. Once symptoms have cleared, a program of deep neck-flexor and cervical strengthening, scapular stabilization and postural correction is started and continued through the season, following Dr. O'Donnell's cervical protocol. Equipment is reviewed: properly fitted shoulder pads, a neck roll or cowboy collar for at-risk positions, and coaching on tackling with the head up.
When a spine surgeon is involved
Dr. O'Donnell refers to a spine surgeon when the MRI shows significant cervical stenosis, cord signal change or a disc herniation with persistent weakness, or when a player has had three or more stingers in a season despite a full program. Those findings decide whether return to contact sport is safe, a decision made with the surgeon, the athlete and the family.
Recovery & What to Expect
Most stingers clear within minutes; a minority take days to weeks. The timeline below is for an episode with lingering symptoms.
| Phase | Timing | What happens |
|---|---|---|
| Sideline | Minutes | Cervical spine cleared; strength, sensation and motion checked; same-game return only if entirely normal and first episode |
| Recovery | Days 1–14 | No contact until exam is normal; ice and anti-inflammatory; neck range of motion; imaging if symptoms persist or recur |
| Strengthen | Weeks 2–6 | Deep neck-flexor, cervical and scapular strengthening; postural endurance; equipment and technique review; non-contact practice |
| Return to contact | Weeks 6–12 | Full painless neck motion and symmetric strength required; graded return to contact; in-season neck program continued |
School, desk work and driving are not interrupted; non-contact training resumes as soon as the exam is normal, and contact sport when strength is symmetric, from the same day for a cleared first episode to 2 to 6 weeks for one with lingering weakness. The strengthening program is the cervical sprain protocol.
Frequently Asked Questions
Can a player go back in the game after a stinger?
Yes, if it is the first episode, symptoms cleared within minutes, and the sideline exam shows full pain-free neck motion, normal strength in the shoulder, elbow and grip, and normal sensation. Any lingering weakness or numbness, neck pain, symptoms in both arms, or a second stinger that day means the player sits out.
How long does a stinger last?
Usually seconds to a few minutes. In a minority, weakness or tingling lasts hours to days, and rarely weeks. Symptoms beyond a few days, or any weakness at 2 weeks, need an MRI and possibly a nerve study, because a persistent stinger may be a disc herniation or a narrowed nerve canal.
Are stingers dangerous?
A single stinger that clears is not; the nerve recovers fully. The concern is repeated stingers, which can leave lasting weakness, and the small group of athletes whose stingers are caused by a narrow cervical canal or a disc herniation, where continuing contact carries a risk of spinal cord injury.
How do I prevent stingers?
Neck and scapular strengthening through the season, tackling with the head up and never leading with the crown of the helmet, and equipment that fits: shoulder pads at the right height and, for at-risk positions, a neck roll or collar that limits extension and side-bending.
When does a stinger need an MRI?
When symptoms last more than a few days, when weakness persists, when both arms or the legs were involved, when neck pain and limited motion accompany it, or when stingers recur in a season. The MRI shows whether a disc herniation, a narrowed nerve canal or a tight spinal canal is the cause, which changes the return-to-play decision.
This page is for general education and is not a substitute for a medical evaluation. Treatment recommendations depend on your individual diagnosis and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.