Rucksack paralysis: Difference between revisions
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==Background== | ==Background== | ||
* Brachial plexus injury as a consequence of carrying a heavy backpack frequently described in military population <ref>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.</ref> | * [[Brachial plexus injury]] as a consequence of carrying a heavy backpack frequently described in military population <ref>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.</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> | * 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> | ||
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* Most often present unilateral | * Most often present unilateral | ||
* Onset may be acute or subacute | * Onset may be acute or subacute | ||
* Minor - electric shock, burning sensation shooting down the arm, numbness/weakness in arm | * Minor - electric shock, [[paresthesia|burning sensation]] shooting down the arm, [[numbness]]/[[weakness]] in arm | ||
* Severe - weakness | * 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== | ==Differential Diagnosis== | ||
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*Toxic neuropathy | *Toxic neuropathy | ||
*Progressive neuropathy secondary to exposure ([[lead]], [[mercury]], [[heavy metals]], chemical solvents) | *Progressive neuropathy secondary to exposure ([[lead]], [[mercury]], [[heavy metals]], chemical solvents) | ||
*See [[weakness]], [[numbness]] | |||
==Evaluation== | ==Evaluation== | ||
* | *Typically clinical diagnosis | ||
* Electrodiagnostic studies EMG, NCV | * Electrodiagnostic studies EMG, NCV (non-emergent) | ||
* | * May consider CT, MRI | ||
==Management== | ==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 <ref> Knapik JJ, Reynolds KL, Harman E. Soldier load carriage: historical, physiological, biomechanical and medical aspects. ''Mil Med'' 2004; 169: 45-56.</ref> | * 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 <ref> Knapik JJ, Reynolds KL, Harman E. Soldier load carriage: historical, physiological, biomechanical and medical aspects. ''Mil Med'' 2004; 169: 45-56.</ref> | ||
* Surgical consultation | * Surgical consultation (nonemergent, generally) | ||
* Physical therapy / occupational therapy | * Physical therapy / occupational therapy | ||
Revision as of 20:13, 1 October 2019
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/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
- Parsonage-Turner syndrome
- Toxic neuropathy
- Progressive neuropathy secondary to exposure (lead, mercury, heavy metals, chemical solvents)
- See weakness, numbness
Evaluation
- Typically clinical diagnosis
- Electrodiagnostic studies EMG, NCV (non-emergent)
- May consider 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 (nonemergent, generally)
- 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.