Patient Information Resources

Alpine Physical Therapy
Three Locations
In North, South, and Downtown Missoula
Missoula, MT 59804
Ph: 406-251-2323
Fax: 406-251-2999

Child Orthopedics
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

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I've had eight stingers now since playing football. Fortunately the pain and numbness down my arm go away in a day or two (at the most). This last time the stinger hasn't gone away. I'm getting X-rays and an MRI today. What will they find out from these tests?

Stingers are common injuries among players involved in contact sports. Getting hit on the head from one side is usually enough to do it. A cervical nerve (coming from the spinal cord to the arm in the neck) gets stretched or pinched. In fact, up to 65 per cent of all football players get at least one stinger. Burning pain down the arm after getting hit is the main symptom. There may be additional symptoms of arm weakness and numbness. The symptoms are usually transient (temporary) and go away within 24-hours. But repeated stingers over time can eventually lead to a chronic stinger syndrome. With a chronic stinger, symptoms of neck and shoulder pain with numbness, tingling, and weakness don't go away. Having a means of predicting who might develop a chronic stinger syndrome would be helpful. With this information, athletes could be advised on the risks associated with repeated stingers. This is important because many athletes who suffer from one stinger will have more than one. Imaging studies (e.g., X-rays, MRIs) are used to help predict who might develop a chronic stinger syndrome. In the past, a ratio called the Torg ratio was used. This is a way of using X-rays to assess the diameter of the opening for the spinal cord and spinal nerve(s). Narrowing of the spinal canal (where the spinal cord is located) causes a condition called stenosis. It's the stenosis that puts pressure on the cord or nerves causing symptoms. It turns out that the Torg ratio is highly sensitive (it accurately tells who has the problem). But it has a poor positive predictive value, which means it doesn't predict who (with stenosis) will develop actual neurologic symptoms. The Torg ratio doesn't account for the effect of the surrounding soft tissues. In using statistical measurements like this, positive predictive values are more clinically meaningful than sensitivity. So, surgeons have turned to the mean subaxial cervical space available for the cord (MSCSAC) index to predict chronic stinger syndrome. This is a measurement made using MRIs that looks at the diameter of the spinal cord in comparison to the diameter of the spinal canal. It gives a much more accurate picture of what's going on and who might develop a chronic stinger syndrome. The tests will show if you have stenosis (narrowing), where it's located, and how severe it is. The results will also give your surgeon an idea of the likelihood of developing a chronic problem (one that doesn't go away). With an acute (first time) injury, most players are back on the field within 24 hours. After eight stingers, the amount of damage to the spine will help determine treatment. The good news is that you will in all likelihood recover full function and return-to-play. But it might take a bit more than a day or two.


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