Rucksack paralysis: Difference between revisions
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* Seen also in boy scouts, hikers, mountaineering <ref> Nylund T, Mattila VM, Salmi T, et al. Recovery of brachial plexus lesions resulting from heavy backpack use: a follow-up case series. ''BMC Musculoskelet Disord'' 2011;12:62. </ref><ref>White HH. . Pack palsy: a neurological complication of scouting. ''Pediatrics'' 1968; 41:1001–3.</ref> | * Seen also in boy scouts, hikers, mountaineering <ref> Nylund T, Mattila VM, Salmi T, et al. Recovery of brachial plexus lesions resulting from heavy backpack use: a follow-up case series. ''BMC Musculoskelet Disord'' 2011;12:62. </ref><ref>White HH. . Pack palsy: a neurological complication of scouting. ''Pediatrics'' 1968; 41:1001–3.</ref> | ||
* Also described secondary to wearing body armor <ref>Bhatt BM. ‘Top Cover Neuropathy’—Transient brachial plexopathy due to body armour. ''JRAMC'' 1990;136:53–4.</ref> | * Also described secondary to wearing body armor <ref>Bhatt BM. ‘Top Cover Neuropathy’—Transient brachial plexopathy due to body armour. ''JRAMC'' 1990;136:53–4.</ref> | ||
* Known by a variety of names | * Known by a variety of names: pack palsy,<ref>Bom F. . A case of pack-palsy from the Korean War . ''Acta Psychiatr Neurol Scand'' 1953; 28:1–4.</ref> backpack palsy, rucksack paralysis,<ref>Daube JR. . Rucksack paralysis. ''JAMA'' 1969; 208:2447–52.</ref> trekker's palsy, Pallbearer's palsy<ref> Loni NK. . Pall-bearer's palsy . ''BMJ'' 1966; 2:808–9.</ref> | ||
* Decreased because of more ergonomically designed packs <ref>De Luigi AJ, Pasquina P, Dahl E. Rucksack induced plexopathy mimicking a lateral antebrachial cutaneous neuropathy. ''Am J Phys Med Rehabil'' 2008;87:773–5.</ref> | * Decreased because of more ergonomically designed packs<ref>De Luigi AJ, Pasquina P, Dahl E. Rucksack induced plexopathy mimicking a lateral antebrachial cutaneous neuropathy. ''Am J Phys Med Rehabil'' 2008;87:773–5.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 09:13, 27 February 2018
Background
- Brachial plexus injury as a consequence of carrying a heavy backpack frequently described in military population [1]
- Seen also in boy scouts, hikers, mountaineering [2][3]
- Also described secondary to wearing body armor [4]
- Known by a variety of names: pack palsy,[5] backpack palsy, rucksack paralysis,[6] trekker's palsy, Pallbearer's palsy[7]
- Decreased because of more ergonomically designed packs[8]
Clinical Features
- Signs and symptoms vary depending on severity and location of injury
- Most often present unilateral
- Onset may be acute or subacute
- Minor - electric shock, burning sensation shooting down the arm, numbness/weakness in arm
- Severe - weakness, inability to use certain muscles of hand/arm/shoulder, complete lack of movement or feeling in arm, severe pain
Differential Diagnosis
- Parsonage-Turner syndrome
- Toxic neuropathy
- Progressive neuropathy secondary to exposure (lead, mercury, heavy metals, chemical solvents)
Evaluation
- History and clinical examination
- Electrodiagnostic studies EMG, NCV
- Imaging studies CT, MRI
Management
- Refrain from back use short term when patient resumes use a back with a frame and hip belt as this will reduce incidence of backpack palsy [9]
- Surgical consultation
- Physical therapy / occupational therapy
Disposition
- Patients usually make full recovery
- Outpatient treatment and follow-up with orthopedics if minor
See Also
External Links
References
- ↑ McCulloch, R., Sheena, Y., Simpson, C., et al. Brachial plexus palsy following a training run with a heavy backpack. J R Army Med Corps October 14, 2013 doi: 10.1136/jramc-2013-000139.
- ↑ Nylund T, Mattila VM, Salmi T, et al. Recovery of brachial plexus lesions resulting from heavy backpack use: a follow-up case series. BMC Musculoskelet Disord 2011;12:62.
- ↑ White HH. . Pack palsy: a neurological complication of scouting. Pediatrics 1968; 41:1001–3.
- ↑ Bhatt BM. ‘Top Cover Neuropathy’—Transient brachial plexopathy due to body armour. JRAMC 1990;136:53–4.
- ↑ Bom F. . A case of pack-palsy from the Korean War . Acta Psychiatr Neurol Scand 1953; 28:1–4.
- ↑ Daube JR. . Rucksack paralysis. JAMA 1969; 208:2447–52.
- ↑ Loni NK. . Pall-bearer's palsy . BMJ 1966; 2:808–9.
- ↑ De Luigi AJ, Pasquina P, Dahl E. Rucksack induced plexopathy mimicking a lateral antebrachial cutaneous neuropathy. Am J Phys Med Rehabil 2008;87:773–5.
- ↑ Knapik JJ, Reynolds KL, Harman E. Soldier load carriage: historical, physiological, biomechanical and medical aspects. Mil Med 2004; 169: 45-56.