Crutch palsy is a relatively rare nerve condition characterized by compression of the brachial plexus (the network of nerves that controls movement and sensation in the arm and hand) due to prolonged or improper use of axillary crutches.
Understanding the Cause
When using axillary crutches, excessive pressure applied in the armpit area can compress the brachial plexus. This compression can damage the nerves, leading to a variety of symptoms. While rare, it's a well-recognized complication, especially in children.
Symptoms of Crutch Palsy
Symptoms can vary depending on which nerves are affected, but commonly include:
- Weakness or paralysis in the arm, wrist, and hand.
- Numbness or tingling in the arm and hand.
- Pain in the shoulder and arm.
- Difficulty with fine motor skills.
Most cases involve the posterior cord of the brachial plexus, affecting the nerves that control the muscles on the back of the arm and hand.
Diagnosis and Treatment
Diagnosis typically involves a physical examination and a review of the patient's history, specifically regarding crutch use. Nerve conduction studies and electromyography (EMG) may be performed to assess the extent of nerve damage.
Treatment primarily focuses on:
- Rest: Avoiding further pressure on the brachial plexus.
- Physical Therapy: Exercises to maintain muscle strength and range of motion.
- Pain Management: Medications for pain relief.
- Proper Crutch Usage Education: Ensuring correct fit and use to prevent future compression.
Fortunately, most cases of crutch palsy resolve spontaneously within 8-12 weeks with conservative management. However, severe cases may require more intensive intervention.
Prevention is Key
Proper crutch fitting and usage are crucial to prevent crutch palsy. Key factors include:
- Correct Height: Crutches should be adjusted so that there's approximately 2-3 finger widths between the top of the crutch and the armpit.
- Weight Bearing on Hands: The hands should bear the weight, not the armpits.
- Proper Gait: Learning the correct walking technique with crutches from a physical therapist or healthcare professional.
