title: Recovery of brachial plexus lesions resulting from heavy backpack use: a follow-up case series.
abstract: BACKGROUND
  Brachial plexus lesions as a consequence of carrying a heavy backpack have been reported, but the typical clinical course and long-term consequences are not clear. Here we evaluated the clinical course and pattern of recovery of backpack palsy (BPP) in a large series of patients.
  
  
  METHODS
  Thirty-eight consecutive patients with idiopathic BPP were identified from our population of 193,450 Finnish conscripts by means of computerised register. A physiotherapist provided instructions for proper hand use and rehabilitative exercises at disease onset. The patients were followed up for 2 to 8 years from the diagnosis. We also searched for genetic markers of hereditary neuropathy with pressure palsies. Mann-Whitney U-test was used to analyze continuous data. The Fischer's exact test was used to assess two-way tables.
  
  
  RESULTS
  Eighty percent of the patients recovered totally within 9 months after the onset of weakness. Prolonged symptoms occurred in 15% of the patients, but daily activities were not affected. The weight of the carried load at the symptom onset significantly affected the severity of the muscle strength loss in the physiotherapeutic testing at the follow-up. The initial electromyography did not predict recovery. Genetic testing did not reveal de novo hereditary neuropathy with pressure palsies.
  
  
  CONCLUSIONS
  The prognosis of BPP is favorable in the vast majority of cases. Electromyography is useful for diagnosis. To prevent brachial plexus lesions, backpack loads greater than 40 kg should be avoided.
authors.affiliation: Centre for Military Medicine, Finnish Defense Forces, Hennalankatu 259, Lahti, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Nylund
authors.forename: Ville M
authors.initials: VM
authors.lastname: Mattila
authors.forename: Tapani
authors.initials: T
authors.lastname: Salmi
authors.forename: Harri K
authors.initials: HK
authors.lastname: Pihlajamäki
authors.forename: Jyrki P
authors.initials: JP
authors.lastname: Mäkelä
mesh_terms: D000293:Adolescent; D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017770:Lifting / Q000009:adverse effects*; D008297:Male; D008889:Military Personnel; D009185:Myelin Proteins / Q000235:genetics; D009784:Occupational Diseases / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology*; D015995:Prevalence; D020127:Recovery of Function / Q000235:genetics / Q000502:physiology*; D013997:Time Factors; D055815:Young Adult
chemical_list: D009185:Myelin Proteins; C073687:PMP22 protein, human