Stinger (medicine)

In

• The time between injury and treatment can be critical in determining the extent of complications and the amount of recovery
• A serious spinal injury is not always immediately obvious. If it is not recognized, more severe injury may occur
• Numbness or paralysis may develop immediately or come on gradually as bleeding or swelling occurs in or around the spinal cord[3]

Mechanism

The three main mechanisms of a stinger include receiving direct blows, extension, and compression of the brachial plexus, with most of the brachial plexus injuries being an extension-compression mechanism.

A stinger is an injury that is caused by restriction of the nerve supply to the upper extremity via the

Since stingers are a nerve injury, a stinger can fall into two different categories of peripheral nerve injury with physiological differences. Grade I is neurapraxia, which involves focal damage of the myelin fibers around the axon, with the axon and the connective tissue sheath remaining intact. The disruption of nerve function involves demyelination. Axonal integrity is preserved, and remyelination occurs within days or weeks.^[7][8] Grade II is categorized by axonotmesis which is the most severe case of nerve injury in the context of stingers and involves the injury of the axon.^[7] Grade III is classified as neurotmesis where there is a complete disruption of the axon, where it is unlikely of recovery. If this is to happen it is not considered a stinger, and usually is a high-energy injury to the shoulder-girdle.^[8]

Diagnosis and treatment

Stingers are best

The order of treatments applied depends on whether the athlete's main complaint is pain or weakness. Both can be treated with an analgesic, anti-inflammatory medication, ice and heat, restriction of movement, and if necessary, cervical collar or traction. Surgery is only necessary in the most severe cases.

Returning to play

Returning from this injury depends on the number of burners that occurs. If a stinger occurs, the athletes usually return to play after they restore full strength, are asymptomatic where no pain persists, and painless range of motion in the cervical spine. At low frequencies of stingers, like 1 or 2, there is a much lower risk of the symptoms reoccurring. If three or more stingers occur in one season, one has a higher increased risk at the symptoms persisting.^[9]

If one is returning from play to contact sports it is important to adopt a strict exercise regimen of the neck muscles so the player has the ability to handle the trauma associated with tackles.^[10]

Prevention

Stingers can be prevented by several of the following factors, but first, it is crucial to identify the severity of the stinger because treatment usually depends on that factor. If strengthening treatment starts too early with a severe case, it can prevent one from healing. The dysfunctions that caused the peripheral nerve injury must be identified to treat and prevent future injury.^[11]

Flexibility and strength of the neck, shoulder, and upper extremity are essential because stiffness and weakness are predisposing factors for a burner as well as consequences of this injury. Factors that could help in the prevention of stingers could include strengthening the muscles, increasing the range of motion, and improving technique when playing.^[12]

Simple measures can be taken to help in the recovery from stingers. A chest-out posture should be adapted to prevent the neck from extending too far because it brings the head over the shoulders. The chest-out posture is emphasized due to it not being commonly adopted by athletes due to developed shoulders and is perpetuated by

Stingers commonly occur in contact sports like wrestling, hockey, basketball, boxing, rugby, weightlifting, and, most notably, football. One study found that up to 65% of college football players have suffered at least one stinger. However, it is difficult to ping an exact number of athletes that suffer from stingers as stingers are historically under-reported. This could be due to the players fear of being removed from play or the injury being viewed as unimportant.[14]

The following study found different frequencies in the number of stingers that occur. Incidence of stingers over a six-year study period with only 1.5 stingers per team each season. Most of the stingers reported were either during competitions or preseason. Exactly 93% of stingers were due to player contact, specifically 36.7% occurring while tackling and 25.8% occurring while blocking.^[15]

History

In 1976 most major American football leagues banned the technique of spearing in the sport due to the risk of injury. When a player makes head-down contact, that player has much more of a chance of a significant spinal cord injury. After the initial rule change, many of the cervical spine injuries stopped.^[16] Therefore, this prompted a new tackling technique to be adopted, such as the head-up tackling technique. This technique does prevent catastrophic spine injuries, but it can result in brachial plexus injuries. After the rule change, it has been estimated that stingers have gone up in prevalence.^[17]

References