- Brachial plexus injury as a consequence of carrying a heavy backpack frequently described in military population 
- Seen also in boy scouts, hikers, mountaineering 
- Also described secondary to wearing body armor 
- Known by a variety of names: pack palsy, backpack palsy, rucksack paralysis, trekker's palsy, Pallbearer's palsy
- Decreased because of more ergonomically designed packs
- 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
- Parsonage-Turner syndrome
- Toxic neuropathy
- Progressive neuropathy secondary to exposure (lead, mercury, heavy metals, chemical solvents)
- See weakness, numbness
- Shoulder Dislocation
- Clavicle fracture
- Humerus fracture
- Scapula fracture
- Acromioclavicular joint injury
- Glenohumeral instability
- Rotator cuff tear
- Biceps tendon rupture
- Triceps tendon rupture
- Septic joint
- Rotator cuff tear
- Impingement syndrome
- Calcific tendinitis
- Adhesive capsulitis
- Biceps tendinitis
- Subacromial bursitis
Refered pain & non-orthopedic causes:
- Referred pain from
- Brachial plexus injury
- Axillary artery thrombosis
- Thoracic outlet syndrome
- Subclavian steal syndrome
- Pancoast tumor
- Myocardial infarction
- Pulmonary embolism
- 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 
- Surgical consultation (nonemergent, generally)
- Physical therapy / occupational therapy
- Patients usually make full recovery
- Outpatient treatment and follow-up with orthopedics if minor
- 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.