Burners (Stingers) Syndrome

Introduction

This Wiki page aims to provide readers with a background understanding of Burner’s syndrome (also known as Stinger’s syndrome), why the young athletic population are more at risk and give an insight into the different management options which are available. We will discuss the various treatment options supported by research evidence, with a focus on the efficacy of each treatment options in returning the athlete to the sport and how to help prevent future recurrence and potentially more severe neurological developments.

What is Burner’s Syndrome?

Burner’s syndrome is a common injury in contact sports and reflects an upper cervical root injury or a peripheral nerve dysfunction injury. It is a transient nerve injury which occurs following over-stretching of the upper trunk of the brachial plexus or compression of the C5/C6 nerve root, depending on the mechanism of injury. Recurrences are common and can lead to permanent neurologic deficits. Burner’s syndrome tends to be a grade I or grade II nerve injury.

Classification of Peripheral Nerve Injuries

Grade I- Neuropraxia; a disruption of nerve function involving demyelination (Warren, 1989; Hershman, 1990). Axonal integrity is preserved, and remyelination follows within three weeks (Warren, 1989).

Grade II- Axonotmesis; in which axonal damage (Warren, 1989) and Wallerian degeneration occur (Hershman, 1990).

Grade III- Neurotmesis;  complete nerve transection (neurotmesis), or permanent nerve damage (Warren, 1989).

https://www.physio-pedia.com/Classification_of_Peripheral_Nerve_Injury

Burners injuries mainly present as a grade I or II classifications (Warren, 1989).

Aetiology

Burners’ may be the most common upper extremity nerve injury seen in competitive athletes. (Dimbergand Burns, 2005; Krivickas and Wilbourn, 1998).

There are three primary mechanisms of injury which may cause Burner’s syndrome:

1. A forceful blow causing depression of the shoulder and lateral flexion of the neck to the contralateral side, leading to traction of the upper roots of the brachial plexus (Sallis et al., 1992; Hershman, 1990; Nicholas, Hershman and Posner, 1995).
2. A direct blow to supraclavicular fossa or Erb’s point causing a percussive injury (Di Benedetto and Markey 1984; Markey, Di Benedetto and Curl 1993; Nicholas, Hershman and Posner, 1995).
3. Compression of nerve roots or brachial plexus when the head is forced into hyperextension and ipsilateral side flexion towards the side of trauma (Watkins, 1986). This significantly narrows the intervertebral foreman at the cervical spine, causing the compression of the nerve root (Hershman and Posner, 1995). However, research revolving around cervical foramen, canal and disc abnormalities is ambiguous. Some studies have shown significant associations with cervical stenosis/foraminal stenosis/disc abnormalities with burners (Odor et al., 1990; Meyer et al., 1994; Kelly et al., 2000), while other studies identified asymptomatic individuals with similar abnormalities (Boden et al., 1990). It also appears that this mechanism of burners syndrome is more commonly seen in high-level athletes (Presciutti et al., 2009).

Epidemiology

Burner’s syndrome is most commonly seen in collision or contact sports such as American football, ice hockey, and rugby. The incidence of this is thought to be rather high; involving between 50 and 65% of collegiate American football players. This statistic is in fact quite likely higher than estimated due to a relatively high incidence of non-reporting by these same collegiate players.

The majority of research has been completed with American football players. It occurs most commonly in linebackers and defensive backs while tackling. It may also occur with running backs or linemen while blocking or being tackled. There is also a very high incidence recurrence, which must be addressed by the medical staff to minimize this problem. Studies conducted on rugby players highlights similar mechanisms of injury, the main one being tackling (Cunnane, Pratten and Loughna, 2011).

Author and Year	Subjects	Prevalence of Burners	Incidence of Non-Reporting	Recurrence Rate
Sallis, Jones and Knopp W, 1992	American college football players	65% of players reported at least one incidence	70%	-
Cunnane, Pratten and Loughna, 2011	English Premiership rugby union football players		-	-
Kawasaki et al., 2015	569 male rugby players