Upper Brachial Plexus Palsy (Rucksack Palsy)

Sam Nahas,Hagen Jahnich,Clarence Yeoh

doi:10.4172/2167-1222.1000419

Abstract

Rucksack palsy is an uncommon injury presumably caused by prolonged traction of the straps of a backpack on the brachial plexus. We present a patient with painless weakness and loss of sensation in her arm. Familiarity with the differential diagnosis of insidious, painless shoulder weakness is essential in managing patients with rucksack palsy. These patients should be treated expectantly and monitored closely.

Highlights

Rucksack palsy is an uncommon injury presumably caused by prolonged traction with the straps of a pack on the brachial plexus
We demonstrate a case of upper brachial plexus palsy caused by carrying a heavy rucksack
Electromyogram (EMG) showed denervated biceps, brachioradial is, supinator, and extensor carpi radialis longus. She was reviewed 4 weeks post nerve conduction study (NCS) and she continued to recover with improvement of her subscapularis, infraspinatus and biceps brachia to Medical Research Council (MRC) grade 4 [2]

Summary

Introduction

Rucksack palsy is an uncommon injury presumably caused by prolonged traction with the straps of a pack on the brachial plexus. A 14-year-old schoolgirl presented to the fracture clinic complaining of painless weakness in her arm and loss of feeling This was after an expedition ‘test’ in preparation for a trekking tour. The upper limb neurological examination demonstrated dysesthesia at the C5 and C6 dermatomes Her muscle power was normal in trapezius, pectoralis major, triceps, wrist extensor, wrist flexors, interossei and the deltoid. It is likely that these symptoms resulted from a mechanical injury causing neurapraxia to the upper trunk of the brachial plexus She was advised against carrying a rucksack on the affected shoulder but encouraged to mobilize the shoulder [1]. Electromyogram (EMG) showed denervated biceps, brachioradial is, supinator, and extensor carpi radialis longus She was reviewed 4 weeks post NCS and she continued to recover with improvement of her subscapularis, infraspinatus and biceps brachia to MRC grade 4 [2]

Discussion

Conclusion