Back-pack palsy in Royal Marine recruits at the Commando Training Centre Royal Marines

Abstract Introduction Peripheral nerve injury secondary to load carrying is a rare condition most often described in military personnel secondary to heavy load carrying for prolonged periods. A series of patients is described presenting with compression neuropathy secondary to load carrying, and their disease characteristics are compared to those described in the literature. Methods Our rehabilitation database was searched for all cases of shoulder neuropraxia reported between 2008-2016 during initial military training of 8790 Royal Marine (RM) recruits. Incidence, median rehabilitation period required to return to mainstream training, affected nerve distribution, and investigations performed were identified. Also described was the long-term outcome in terms of recovery from neuropathy and onward fitness for RM service. Results The incidence of shoulder neuropraxia in RM recruits during training was 330 per 100,000. Of the 29 patients identified, 66% made a full recovery over a median period of 20 weeks. Median follow-up time was 2.3 years. The most common nerve affected was the axillary nerve. Conclusion Shoulder neuropraxia is more common in the RM recruit population than in other previously studied groups. This could be explained by the arduous nature of the loaded marches during RM recruit training, the load including heavy packs, irregular terrain and long distances. Emphasis should be placed on prevention, by providing good recruit education on appropriate kit adjustment during load carries and early identification of symptoms.