Crutch Palsy

 What is a Crutch Palsy?

Crutch palsy

Crutch palsy, also known as crutch-induced neuropathy or crutch paralysis, is a neuropathic condition induced by the improper use or prolonged usage of crutches. 

The general area of involvement includes either the radial nerve or the brachial plexus, which can commonly be associated with pressure applied upon the axilla, or armpit area. A person who has to use crutches for a long time after injury or surgery is considered at high risk due to improper or long-term use.

Causes of Crutch Palsy

The most common cause of crutch palsy includes pressure sustained by the radial nerve or brachial plexus in the axilla. Crutches are designed to support a person's body by distributing the person's weight onto the hand and forearm; however, most users unknowingly allow their axilla to rest on the top of the crutch, causing compression of nerves.

The pressure can damage the radial nerve running through the armpit down to the wrist and hand, with symptoms generally related to the upper limb.

Key causes include:

• Incorrect Use of Crutches: Resting the weight of the body on top of the crutches instead of the handles.
• Prolonged Use of Crutches: When the crutches are used for too long without making necessary adjustments, it can increase the chances of injury.
• Poorly Fitted Crutches: Crutches that are either too high or low can be the cause of abnormal pressure points, especially in the underarm area.
• Poor Upper Body Strength: Individuals with poor strength in their shoulders, arms, or hands will put additional strain on the underarm region that places extra tension on the nerves.

Symptoms of Crutch Palsy

Symptoms of crutch palsy are in regard to the damage or compression of a nerve and can hence not be objectively put on a scale. They may all generally involve:

• Weakness of the wrist but more of the fingers: Patients are unable to extend the wrist and fingers - wrist drop.
• Loss of sensation: Numbness and tingling in the rear hand, and forearm are common.
• Pain/Discomfort: Pain may be in the armpit, arm, forearm, or hand.
• Reduced Grip: The experience of not being able to hold objects due to weakened hand muscles.
• Muscle Atrophy: In conditions of severe or prolonged loss of nerve function, the wasting of muscles may be seen in the affected area.

Diagnosis

The diagnosis for crutch palsy is actually done through detailed physical examination by the health care provider; questions about the use of crutches and its duration, aside from symptoms being reported. Further tests to confirm this diagnosis may be:

• Nerve Conduction Studies: This is utilized to establish the functioning of the radial nerve and the level at which the nerve damage has occurred.
• Electromyogram (EMG): Assess the electrical activity of the involved muscles, which may help differentiate weakness in the muscles that might result from impairment of nerves.
• Imaging Studies: These could include an MRI or ultrasound in order to rule out other causes of compression of the radial nerve, such as masses or abnormal structures.

Treatment of Crutch Palsy

Treatment of crutch palsy is mainly aimed at relieving the compression on the nerves and restoration of the affected arm and hand to functionality. Treatments incorporate the following:

• Rest and Avoiding Crutches: The avoidance of using crutches or making sure not to put pressure on the crutches relieves the pressure on the radial nerve.
• Physical Therapy: Starting to strengthen the muscle, stretching, and range-of-motion activities to help restore function and strength to the affected limb. Occupational therapy can be given too.
• Pain Management: Over-the-counter pain medications may be prescribed, which include NSAIDs for dealing with pain and inflammation.
• Orthotics: Immobilizing by splinting or bracing can be done to support the wrist in cases of wrist drop that helps to continue functional use of the hand.
• Nerve Gliding Exercises: These exercises may be employed to enhance nerve mobility and decrease the adhesions that may affect nerve recovery anytime.
• Surgical Intervention: On rare occasions, when nerve compression is not resolved and significant muscle atrophy or functional decline occurs, surgical decompression or nerve graft may be indicated.

Prevention of Crutch Palsy

Crutch palsy can be prevented by the proper use of crutches and proper fitting to the height and structure of the body.

Proper Fit of Crutches: The crutches should be fitted so that there is about a 1- to 2-inch gap between the top of the crutch and the armpit.

Grasping Handgrips for Support: Most of the body weight must be supported by the hand grips and not by the underarm.

Limit the Use of Crutches When Not Necessary: For chronic mobility needs, alternative devices such as walkers may be less harmful to the nerves.

Frequent Rest: Taking occasional breaks from the crutches can help prevent restricted pressure on the underarm nerves.

Recovery and Prognosis

The prognosis for crutch palsy largely depends on the severity and duration of nerve compression. Most people will show great improvement over several weeks to months with early diagnosis and good management. For cases with significant nerve damage, recovery may take longer, and some residual weakness or numbness may persist. Recovery outcomes can be optimized by undertaking regular physical therapy and adhering to medical advice.

Summary

Crutch palsy is a preventable neuropathy that results from improper or prolonged use of crutches. Knowledge of proper crutch ambulation, appropriate fitting, and minimizing underarm pressure are crucial to prevent this condition. With prompt diagnosis and treatment, recovery is usually complete, although severe cases may require more intensive rehabilitation.