Epidemiology of Stingers in the National Football League, 2015-2019

Abstract

Background: Transient traumatic neuropraxia of either the brachial plexus or cervical nerve root(s) is commonly described as a "stinger" or "burner" by the athlete. Stingers in American Football commonly occur acutely as isolated injuries; however, concomitant injuries, including cervical spine pathologies, have also been reported.

Hypothesis: Among National Football League (NFL) athletes, the incidence rate of stingers is higher during the regular season than during the preseason and among positions with high velocity impacts such as running backs, linebackers, defensive backs, and receivers.

Study design: Retrospective epidemiology study.

Level of evidence: Level 4.

Methods: Aggregation of all in-game injuries with a clinical impression of "neck brachial plexus stretch" or "neck brachial plexus compression" entered into the NFL injury surveillance database through the centralized league-wide electronic medical record system over 5 years (2015-2019 seasons). Incidence rates per player-play were calculated and reported.

Results: A total of 691 in-game stingers occurred during the study period, with a mean of 138.2 per year. Average single-season injury risk for incident stinger was 3.74% (95% CI, 3.46%-4.05%). The incidence rate was higher during regular season games than during preseason games (12.26 per 100,000 player-plays [11.30-13.31] vs 8.87 [7.31-10.76], P < 0.01, respectively). The highest reported stinger incidence rates were among running backs and linebackers (both >15 per 100,000 player-plays). Among stingers, 76.41% did not miss time. Of those that resulted in time lost from football activities, mean time missed due to injury was 4.79 days (range, 3.17-6.41 days). Concomitant injuries were relatively low (7.09%).

Conclusion: In-game stinger incidence was stable across the study period and occurred most frequently in running backs and linebackers. Stingers were more common during the regular season, and most players did not miss time. Concomitant injuries were relatively rare.

Clinical relevance: An improved understanding of the expected time loss due to stinger and concomitant injuries may provide insight for medical personnel in managing these injuries.

Keywords: National Football League; brachial plexopathy; burner; cervical; professional athletes; stinger.

Figure 1.

Number of NFL game-related stingers each year from 2015 to 2019 in the regular season, preseason, and postseason. NFL, National Football League.

Figure 2.

Concomitant injuries to NFL players who experienced in-game stingers during the 2015 to 2019 seasons. “Cervical spine injury” includes diagnoses of cervical disc derangement, cervical disc disease, cervical disc herniation, cervical stenosis, and cervical fracture. “Shoulder injury” includes diagnoses of shoulder contusion, shoulder strain, shoulder sprain, acromioclavicular sprain, glenoid labral tear, shoulder nerve disorder, and rotator cuff tear. “Other” includes diagnoses of elbow contusion, rhomboid strain, sternoclavicular sprain, and chest fracture/rib injury. NFL, National Football League.