PRESS RELEASE

May 3, 2004
FOR IMMEDIATE RELEASE
 
PROBLEMATIC STINGERS
 
The stinger is a common neurologic injury occurring in sports, particularly in contact and collision sports such as football and wrestling, presents Dr. Weinstein at the annual AMSSM conference in Vancouver, BC.  It is a peripheral nerve injury most likely occurring at the cervical nerve root/spinal nerve level.  Athletes usually experience acute “electrical-like” pain sensations followed by painless weakness in a specific nerve root distribution. Stingers can be persistent, recurrent and thus “problematic” leading to substantial lost time from competition or risk of secondary injury.  Dr Weinstein points out that athletes with prolonged time to resolution after an initial event (i.e.  > three weeks) and recurrent stingers over a relatively short duration (e.g. two or more stingers in one season) tend to do more poorly. 
 
The diagnostic evaluation of a “problematic” stinger includes: cervical x-rays; MRI or contrast-enhanced CT to assess for foraminal stenosis (most common) or disc herniation (less common); and electrodiagnostics.  A normal EMG performed more than three weeks after onset of weakness suggests a neurapraxic injury (more transient) with a more positive prognosis. 
 
Rest from practice and competition is usually the initial treatment of choice. Quick resolution of symptoms and signs, including a normal detailed strength assessment and absence of a Spurling’s sign (test physician performs) should allow return to play following a single injury.  In athletes with persisting or recurring problems, more specific interventions are necessary.  These include manual physical therapy to improve postural dysfunctions (i.e. the classical forward head posture), neck and back core strengthening exercises, and at times cervical injections (i.e. nerve root blocks).  Injections should be used cautiously and only when a spine physician is experienced with them.
 
Finally, cervical spine surgery for some athletes with persistent or recurrent stingers can be considered. Unfortunately, long-term success and return to play diminish with spinal fusion procedures.  Thus, these procedures are only considered after comprehensive rehabilitation fails and if the socio-economic factors warrant this aggressive approach.
 
Dr. Weinstein is a charter member of the AMSSM and is the president-elect of the Physiatric Association of Spine, Sports and Occupational Rehabilitation (PASSOR).
 
The American Medical Society for Sports Medicine (AMSSM) was organized in 1991by physicians who recognized the need for an organization within the field of sports medicine that approached athletes, exercising individuals, and teams comprehensively with consultative and continuous care of their orthopedic, medical, nutritional, and psychosocial issues.  Although sports medicine concepts are often thought of in conjunction with professional and elite athletes, these concepts apply to athletes of all levels including grade school, high school, college and recreational athletes.  AMSSM is comprised of over 800 Sports Medicine Physicians whose goal is to provide a link between the rapidly expanding core of knowledge related to sports medicine and its application to patients in a clinical setting.

NOTE: For more information, please contact the AMSSM, 11639 Earnshaw, Overland Park, KS 66210, (913) 327-1415 or office@amssm.org .