Treatment for Stinger Shoulder
For a stinger shoulder injury, immediate removal from play, rest, and ice application are the primary treatments, with return to play only after symptoms fully resolve and normal strength returns. 1, 2, 3
Understanding Stinger Injuries
- A stinger (also called burner syndrome) is a common neuropathy caused by traction or compression of the brachial plexus, typically occurring during contact sports 2, 3
- Characterized by acute lancinating pain in one upper extremity, often with associated weakness, numbness, and sometimes without neck pain 3
- Most commonly affects the C6 nerve root rather than being a lateral stretch of the brachial plexus as previously thought 4
- Can occur in athletes of any age, though most common in young adults involved in contact sports 2, 5
Initial Assessment
- Document the exact mechanism of injury, including position of the shoulder and neck at time of impact 6
- Assess neurovascular status, including pulse strength, sensation, and motor function in the affected arm 6
- Evaluate for pain characteristics, location, and severity 6
- Rule out more serious injuries to the head, spine, or shoulder girdle before considering return to play 3
Immediate Management
- Remove athlete from play for proper evaluation 3, 4
- Apply ice to the affected area to reduce inflammation 1
- Consider over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs for pain relief 1
- Apply cold packs for local pain relief 1
Return to Play Criteria
- Athletes should not return to competition until all abnormal neurologic signs disappear 4
- For symptoms resolving in less than 5 minutes, return to play may be allowed 1
- For symptoms lasting more than 5 minutes, return to play should be evaluated on a case-by-case basis 1
- Athletes with recurrent stingers, persisting pain, or strength deficits require thorough diagnostic evaluation before return-to-play decisions 3
Imaging and Further Evaluation
- Radiographs should be performed if there is concern for fracture or dislocation 1
- MRI may be considered for persistent symptoms, though it may be normal despite nerve injury 5
- Electromyography (EMG) is valuable for diagnosis, as it typically shows denervation even when MRI is normal 5, 4
- Consider obtaining an MRI after a second stinger episode 1
Rehabilitation
- Begin active and passive motion exercises once acute pain subsides (typically after 1-2 weeks) 2
- Focus rehabilitation on strengthening the rotator cuff, periscapular muscles, and core musculature 1
- Improve flexibility of the shoulder capsule 1
- For athletes with shoulder laxity contributing to stinger syndrome, consider a shoulder-arm brace 2
Long-term Considerations
- In some cases, players sustaining multiple recurrent stingers may need to be permanently removed from participation in collision or contact sports 3
- Athletes with a history of stingers should undergo preseason strengthening programs 1
- Proper tackling technique should be emphasized to prevent recurrence 4