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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2022; 80(06): 658
DOI: 10.1590/0004-282X-ANP-2021-0427
Images in Neurology

Rucksack palsy after military boot camp

Paralisia do mochileiro após treinamento militar
Pedro Henrique Almeida Fraiman 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.
2   Hospital de Guarnição de Natal, Exército Brasileiro, Natal RN, Brazil.
,
Igor Matheus Diniz Papa 
2   Hospital de Guarnição de Natal, Exército Brasileiro, Natal RN, Brazil.
,
Bruno de Medeiros Fernandes 
2   Hospital de Guarnição de Natal, Exército Brasileiro, Natal RN, Brazil.
,
Fernanda Thaysa Avelino dos Santos 
2   Hospital de Guarnição de Natal, Exército Brasileiro, Natal RN, Brazil.
,
Clecio Godeiro-Junior 
3   Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Divisão de Neurologia, Natal RN, Brazil.
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A 18-year-old soldier reported weakness on the abduction of right arm and mild right shoulder pain five days after wearing a rucksack during a 3-day boot camp training ([Figure 1-A]). After six weeks, he presented hypotrophy of shoulder girdle muscles and winged scapula ([Figure 1-B]). An electroneuromyography performed at this moment revealed signs of progressive subacute neurogenic motor unit potentials of right deltoid, biceps brachii and anterior serratus ([Figure 1-C]). Right brachial plexus, shoulder MRI and a viral serum panel were unremarkable.

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Figure 1 Rucksack palsy. (A) Military rucksack carries a load of approximately 15 kilograms; superior armpit is a point of compression (white arrows). It is the result of traction of brachial nerves on scalene muscles caused by the shoulder straps of a heavy rucksack. (B) Hypotrophy of right shoulder girdle muscles, more prominent deltoid, supraspinatus, biceps brachii muscles, and winged scapula. (C) Electroneuromyography signs of progressive subacute neurogenic motor unit potentials of right deltoid, biceps brachii, anterior serratus suggesting pathology of the brachial plexus.

Rucksack palsy is most described in the military population[1]. It is associated with damage to the brachial plexus as a result of wearing a heavy rucksack[2].


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Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

PHAF, FTA: analysis and interpretation of data, writing and drafting the manuscript; IMDP, BMF: analysis and interpretation of data; CGJ: critical revision of the manuscript for intellectual content.



Address for correspondence

Pedro Henrique Almeida Fraiman

Publication History

Received: 26 October 2021

Accepted: 27 January 2022

Article published online:
06 February 2023

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Zoom Image
Figure 1 Rucksack palsy. (A) Military rucksack carries a load of approximately 15 kilograms; superior armpit is a point of compression (white arrows). It is the result of traction of brachial nerves on scalene muscles caused by the shoulder straps of a heavy rucksack. (B) Hypotrophy of right shoulder girdle muscles, more prominent deltoid, supraspinatus, biceps brachii muscles, and winged scapula. (C) Electroneuromyography signs of progressive subacute neurogenic motor unit potentials of right deltoid, biceps brachii, anterior serratus suggesting pathology of the brachial plexus.