Rucksack paralysis

(Redirected from Pack palsy)


Brachial plexus surrounding the brachial artery.
Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.
Dermatomes and cutaneous nerves - anterior
Dermatomes and cutaneous nerves - posterior
  • 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/paralysis, numbness, severe pain
  • C5 injury:
    • weakness of deltoid and infraspinatus causes adducted, internally rotated shoulder
  • C6 injury:
    • weakness of biceps causes elbow extension
  • C7 injury:
    • weakness of extensor muscles causes wrist and digit flexion

Differential Diagnosis

Shoulder and Upper Arm Diagnoses



Refered pain & non-orthopedic causes:


  • Typically clinical diagnosis
  • Electrodiagnostic studies EMG, NCV (non-emergent)
  • May consider CT, MRI


  • 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 (nonemergent, generally)
  • Physical therapy / occupational therapy


  • Patients usually make full recovery
  • Outpatient treatment and follow-up with orthopedics if minor

See Also

External Links


  1. 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.
  2. 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.
  3. White HH. . Pack palsy: a neurological complication of scouting. Pediatrics 1968; 41:1001–3.
  4. Bhatt BM. ‘Top Cover Neuropathy’—Transient brachial plexopathy due to body armour. JRAMC 1990;136:53–4.
  5. Bom F. . A case of pack-palsy from the Korean War . Acta Psychiatr Neurol Scand 1953; 28:1–4.
  6. Daube JR. . Rucksack paralysis. JAMA 1969; 208:2447–52.
  7. Loni NK. . Pall-bearer's palsy . BMJ 1966; 2:808–9.
  8. 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.
  9. Knapik JJ, Reynolds KL, Harman E. Soldier load carriage: historical, physiological, biomechanical and medical aspects. Mil Med 2004; 169: 45-56.