Cervical Stinger / Brachial Plexus Neuropraxia

A cervical stinger (or burner) is a transient, one-sided neuropraxia of the upper trunk of the brachial plexus or a cervical nerve root, usually after a collision in contact sport.

Burning, electric pain runs from the neck into the arm with brief weakness or tingling, usually settling within seconds to minutes. It is common in rugby, American football, ice hockey and wrestling.

The clinical priority is to tell a benign one-sided stinger from cervical spine fracture, cervical cord neuropraxia (symptoms in both arms or all 4 limbs), concussion and cervical radiculopathy.

The brachial plexus forms from the ventral rami of C5 to T1. The upper trunk (C5-C6) is most often affected, giving the typical pattern: shoulder and lateral arm symptoms with weakness of deltoid, biceps, supraspinatus and infraspinatus.

There are 3 mechanisms:

• •Traction: neck flexed sideways away from the affected side with the shoulder depressed, stretching the upper trunk; the classic pattern in young athletes
• •Compression: neck flexed sideways towards the affected side and extended, compressing the exiting root in the foramen; more common in older athletes with foraminal narrowing
• •Direct blow to Erb's point in the supraclavicular fossa

The typical stinger is a Sunderland grade I neuropraxia: focal demyelination with the axon intact. Prolonged or recurrent stingers may include axonal injury (axonotmesis), with slower recovery and persistent weakness.