Rucksack paralysis - Revision history

Rossdonaldson1: /* Background */

2020-05-21T20:53:24Z

Background

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	[[File:Gray523.png\|thumb\|Brachial plexus surrounding the brachial artery.]]		[[File:Gray523.png\|thumb\|Brachial plexus surrounding the brachial artery.]]
	[[File:Brachial plexus 2.png\|thumb\|Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.]]		[[File:Brachial plexus 2.png\|thumb\|Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.]]
			[[File:Dermatomes and cutaneous nerves - anterior.png\|thumb\|Dermatomes and cutaneous nerves - anterior]]
			[[File:Dermatomes and cutaneous nerves - posterior.png\|thumb\|Dermatomes and cutaneous nerves - posterior]]
	* [[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>

Rossdonaldson1: /* Background */

2020-05-21T20:52:59Z

Background

← Revisión anterior		Revisión del 20:52 21 may 2020
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	==Background==		==Background==
			[[File:Gray523.png\|thumb\|Brachial plexus surrounding the brachial artery.]]
			[[File:Brachial plexus 2.png\|thumb\|Anatomical illustration of the brachial plexus with areas of roots, trunks, divisions and cords marked.]]
	* [[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>

Rossdonaldson1: /* Differential Diagnosis */

2020-05-21T20:48:30Z

Differential Diagnosis

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	*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]]		*See [[weakness]], [[numbness]]
			{{Shoulder DDX}}

	==Evaluation==		==Evaluation==

ClaireLewis at 20:13, 1 October 2019

2019-10-01T20:13:39Z

← Revisión anterior		Revisión del 20:13 1 oct 2019
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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~~, inability to use certain muscles of hand~~/~~arm/shoulder~~, ~~complete lack of movement or feeling in arm~~, severe pain		* 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==
	* ~~History and~~ clinical ~~examination~~		*Typically clinical diagnosis
	* Electrodiagnostic studies EMG, NCV		* Electrodiagnostic studies EMG, NCV (non-emergent)
	* ~~Imaging studies~~ CT, MRI		* 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

Rossdonaldson1: /* See Also */

2018-02-27T09:17:51Z

Rossdonaldson1: /* Differential Diagnosis */

2018-02-27T09:14:43Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	: Parsonage-Turner syndrome		*Parsonage-Turner syndrome
	: 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)

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Background */

2018-02-27T09:13:34Z

Background

← Revisión anterior		Revisión del 09:13 27 feb 2018
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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 ~~over the years from~~ 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>		* 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==

Rossdonaldson1: /* Background */

2018-02-27T09:12:02Z

Background

← Revisión anterior		Revisión del 09:12 27 feb 2018
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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>
	* Known by a variety of names over the years from 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>		* Known by a variety of names over the years from 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>

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Created page with "==Background== * Brachial plexus injury as a consequence of carrying a heavy backpack frequently described in military population <ref>McCulloch, R., Sheena, Y., Simpson, C.,..."

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==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>
* 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>
* Known by a variety of names over the years from 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>

==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 <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
* Physical therapy / occupational therapy

==Disposition==
* Patients usually make full recovery
* Outpatient treatment and follow-up with orthopedics if minor

==See Also==
[[Brachial plexus injury]]

==External Links==

==References==
<references/>

[[Category:Military]]

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	==See Also==		==See Also==
	[[Brachial plexus injury]]		*[[Brachial plexus injury]]

	==External Links==		==External Links==