Shoulder Injuries in the Performing Arts: "Stingers"

This is the third and final article in a series on shoulder injuries in the performing arts. This series of articles addresses fairly damaging acute shoulder injuries. Unless otherwise noted, these injuries are substantial enough that they should not be self-treated until after you've seen a medical professional who has instructed you to do so. These traumatic shoulder injuries should be treated as emergencies, since there is a high risk of significant complications if they are improperly or incompletely cared for (these complications can include nerve damage, internal bleeding, and nonunion fractures).

The first article in this series discussed shoulder dislocations. It also cleared up some commonly confused terminology. To help you understand the terminology used in this article, a portion of the previous article is reprinted here:

“When it comes to shoulder injuries, there is often some confusion surrounding terminology. Some of this is due to the use of the word "shoulder" as a bit of a catch-all term to describe the entire interconnected system spanning from the center of the body to the upper arm (in front and back). Remember the kids' song that goes "the hip bone's connected to the...thigh bone....")? Turns out, it's (mostly) true - everything's connected.

The true shoulder joint is the glenohumeral joint - the ball and socket joint between the upper arm bone and the trunk. The scapula, also called the shoulder blade, is part of the glenohumeral joint, forms a joint with the collarbone, and is connected to the spine through muscles in the upper back. Muscles in the chest, neck, and upper and lower back direct the positioning and movement of the true shoulder joint. Therefore, thinking of the shoulder joint in isolation from the rest of the regions of the body that affect it is not only difficult, but it makes no sense. This is why medical professionals use the term "shoulder girdle" to describe the entire system surrounding the shoulder joint, including the collar bone, shoulder blade, humerus (upper arm bone), spine, and all of the muscles associated with the shoulder.”

This article discusses “stingers.” While they are not technically an injury to the shoulder girdle, stingers are included in this series of articles because they can often occur at the same time as other shoulder injuries and can negatively affect function of the shoulder and arm.

Stingers

What you feel

“Stingers” are also sometimes called “burners” and have earned their nicknames due to the characteristic pain, numbness, and tingling that runs from the shoulder down into the hand and fingers. This stinging and burning is caused by an injury to the nerve. All nerves react to injurious forces (direct blow, stretching, pinching) in the same manner. So, a stinger feels very similar to the shooting pain and tingling you feel when you “hit your funny bone.” However, the symptoms of a stinger are often more intense than hitting your “funny bone” due to the fact that more nerves are injured in a stinger.

In addition to pain, numbness, and tingling, you’ll also feel a little bit of weakness or a loss of function of the arm and hand (you’ll feel like your brain can’t “talk” to your hand). The symptoms typically last for a few minutes, but severe stingers (or getting stingers frequently) can result in symptoms that take several days to completely resolve.

When a stinger happens, your body will naturally want to have you do one of two things: 1) hang your arm loosely at your side, not wanting to move it at all, or 2) shake your hand and arm while clenching and spreading your hand to attempt to regain feeling or shake out the tingling sensation.

If you experience stinger-like symptoms that are on both sides of your body and/or have limited neck range of motion in any direction, go to the emergency room for further evaluation and diagnostic imaging.

What happens to your body

“Stingers” aren’t technically a shoulder injury – they’re an injury to the bundle of nerves called the brachial plexus. The brachial plexus is a grouping of nerves running from your neck, through your armpit and down into your arm; some of the nerves extend all the way to your fingers. Typically, the nerve grouping becomes injured through a stretch (nerve traction injury), but it can also be compressed/pinched or contused (hit/bruised).

Any force that’s strong enough to cause a stinger may also be strong enough to cause any of a number of other injuries, including:

• Muscle strains (typically in the neck/upper shoulder)
• Fractures: collarbone, one or more neck bones (cervical vertebrae), acromion process (located on the shoulder blade)
• AC Joint sprain (separated shoulder)
• Joint dislocation: shoulder (glenohumeral joint), one or both of the joints on either side of the collarbone (SC joint and AC joint), first rib
• Contusion

How it can happen in the performing arts

Stingers caused by a nerve traction (stretch) occur when the head/neck is forced to the side while the opposite shoulder is forced down (toward the feet). When the neck is extended (bent backward), compressed, and rotated, nerve compression or “pinching” on the side the neck/head is rotated toward can cause a stinger. Stingers caused by contusions occur when the brachial plexus suffers a direct blow.

Any of the three causes of stingers described above can happen in the performing arts, but the first one – nerve traction injury – is the most common. A stretch-based stinger can happen due to an accident like a fall, collision, or having something fall onto your shoulder; a missed shoulder catch in dance; improperly executed floor work; or an external force from another performer (like someone yanking your arm downward when they’re on the floor).

Most often, stingers in the performing arts occur unexpectedly during movements or choreography that has been performed repeatedly without a problem. Most stingers are caused by what most people would characterize as an accident or a “fluke” and are rarely experienced again during that same action. However, if you experience stingers frequently, attempt to identify the cause and make adjustments to prevent experiencing more stingers in the future. Repeated nerve stretch injuries can result in chronic inflammation and dysfunction of the nerve, potentially leading to muscular atrophy and permanent nerve damage.



Be sure to read about shoulder dislocations and shoulder “separations” in the first two articles of this series.