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Look before you leap if liable to pressure palsies

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People with hereditary neuropathy with liability to pressure palsies (HNPP) should be warned against sports like parachuting and rock climbing because of their increased risk of severe nerve injury from tight harnesses.

An unusual case report describes how an 18 year old woman with no history of HNPP experienced lasting weakness in both arms during her first parachute jump. She was harnessed by tight shoulder straps to an instructor, and during the jump felt pain in her left shoulder. On landing she could not move either arm or get up. About 80% strength returned to her right arm after 5–10 minutes but her left remained numb and weak.

A week later she had no pain in her neck, back, or legs or weakness or tingling but still had mild weakness and slow reflexes in the right arm and severe weakness and no reflexes in the left. This suggested cervical central cord syndrome, but an MRI scan showed no abnormalities. Nerve conduction studies and electromyography two weeks after the event showed sensorimotor neuropathy in the arms and legs and prolonged latency of conduction at classic compression sites but no active denervation. Fluorescent in situ hybridisation disclosed a deletion on chromosome 17p11.2 characteristic of HNPP. Recovery took nine months.

Involvement of nerves in both arms is unusual and probably arose from the tight harness. Patients with HNPP suffer recurring nerve injury after the mildest compression forces, and carrying heavy weights over their shoulders, resting on their elbows, or crossing their legs is discouraged.

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