Patrick Kaleta delivers a gentle love-tap to Brad Richards.

Patrick Kaleta delivers a gentle love-tap to Brad Richards.

Patrick Kaleta attempted to decapitate Brad Richards over the weekend with a shove from behind into the boards. Amazingly Richards didn’t die. He did lie on the ice for several minutes not moving his arms and wearing an agonized facial expression. While Kaleta apologists continue to insist this was a FIFA-style dive, anyone who’s ever had a stinger is offering up a hearty bird-flip at that suggestion.

A stinger isn’t a real thing. You made that up.

No, chuckles. It’s real, and it hurts. A stinger (or a burner, or a cervical pinch, or OH GOD MY ARM JUST DIED) is a relatively common sports injury that happens when the head moves in ways heads don’t like to move. There’s a big bundle of nerves called the brachial plexus that runs out of the spine and into the arm that’s responsible for everything the arm does. Smash or stretch that bundle of nerves and you’ll have the unenviable position of owning an arm that both doesn’t work, and feels like it’s on fire.

 

See the important stuff? That runs your arm.

See the important stuff? That runs your arm.

 

Like all nerves, those in the brachial plexus would rather be left alone. If you crush it, stretch it, or whack it, you’ve got problems. You can get a stinger in one of three ways, and from the looks of things Brad Richards could potentially have had two out of the three.

 

Great ways to piss off the nerves of your brachial plexus: A) Stretch them, B) Whack them, C) Crush them.

 

Richards hit the boards with the left side of his neck, and it’s tough to tell from the video which arm was bothering him. He just looks generally miserable.

Then why did that diving jerk come back so fast?

Mostly because stingers are usually transient, and that wasn’t a dive. I’ve never met the guy, so I’m plus/minus on the jerk part. The sudden stretch or crush of the nerve fibres temporarily blocks conduction, and you’re left with a combination of pain/numbness/tingling/the inability to move/no sensation. It resolves in short order, and everything starts working again.

Calgary’s Daymond Langkow had a similar but far more terrifying injury in 2010 when he took a puck in the back of the neck and did to his spinal cord what Richards likely did to his brachial plexus. For thirty minutes Langkow was effectively quadraplegic, but he regained complete function and was cleared to play six weeks later. The only reason it took so long is the slapshot his spine stopped broke one of his vertebrae. The imaging they did on Langkow’s neck is amazing for not just the broken vertebrae and massive bruise, but for the fact that his cord is sitting pretty, completely untouched. Langkow suffered a spinal cord concussion, which is the equivalent of a stinger’s older brother that just got out of jail for boosting cars.

 

A. The spinous process (back part that stick out) of C3 is broken. B. It's seriously broken. See how broken it is? C. THAT is a bruise. D. It's seriously a really big bruise.

A. The spinous process (the back part that sticks out) of C3 is broken. B. It’s seriously broken. See how broken it is? C. THAT is a really big bruise. D. It’s seriously a really really big bruise.

 

 So how do you treat stingers?

The symptoms will generally go away in a few minutes, but a complete neuro evaluation is key to making sure there’s not some horrible neck injury lurking beneath the surface (which would be why Richards disappeared down the tunnel for a few moments). Are the symptoms completely gone? Stinger. Are there any specific areas of tenderness? Not a stinger. Is their neck stable? Stinger. Is their neck unstable? Not a stinger, and GET THE PARAMEDICS NOW NOW NOW. A thorough physical exam to make sure you haven’t missed a fractured clavicle or vertebrae, check reflexes, and test the involved muscles. The muscle testing involves one of the best-named tests ever – the beer can abduction. Hold your arm out from your side at 90 degrees, bend your elbow, and pretend your’re holding a beer. Congratulations, your supraspinatus muscle works.

If the symptoms don’t go away quickly, then x-rays, CT scans, MRI and EMG (electromyography ie muscle conduction testing) come into play, and you’re no longer looking at a stinger. Then it creeps into the territory of spinal/nerve/disc injury.

How do you prevent stingers?

Stay away from Patrick Kaleta. Also important are strength and flexibility training, because as in almost all things orthopedic those are what will minimize injury and maximize recovery. Other sports have developed protective equipment to minimize head movement, but it’s difficult to imagine a hockey application for the collars football players wear. While they reduce loading on the neck (in lab tests, if not necessarily in real life), they also limit mobility quite a bit, to the point that you won’t see them on any position that requires much head movement.

What’s ahead for Richards?

Once you’ve had a stinger, you’re predisposed to getting them again. It’s not as likely in hockey as in football, but the possibility exists. Not only that, but stingers can have delayed onset of muscle weakness, pain, or numbness and tingling. Richards will likely be having repeated exams for the next few weeks until it’s clear that he’s truly back to 100%. He left early yesterday then didn’t dress for the Rangers game against Philadelphia due to some sort of undisclosed aches/pains that have only been described as “he’s banged up” (FYI that’s not a billable diagnosis). John Tortorella has said this isn’t a long-term thing, perhaps evidenced by the fact that he wasn’t scratched until quite close to game time. At any rate we won’t know anything solid until the Rangers get a little more specific about Richards’ condition (that’s never going to happen), or he shows back up on the ice.

More terrifying neck bending:

Stick tap to Erin of Defending Big D for bringing up Ruslan Salei’s hit on Mike Modano in 1999. Holy CRAP.