Bilateral brachial plexus compressive neuropathy (crutch palsy).
Brachial plexus compressive neuropathy following the use of axillary crutches (crutch palsy) is a rare but well-recognized entity. Most reported cases involve the posterior cord of the brachial plexus in children and have resolved spontaneously within 8-12 weeks. We recently treated a 36-year-old man who was using axillary crutches for mobilization after a supracondylar femoral fracture. Bilateral posterior cord (predominantly radial nerve) compressive neuropathy subsequently developed, with lesser involvement of the ulnar and median nerves. The patient had little to no improvement clinically 8 weeks after the estimated onset of the palsy, and an electromyogram at that time confirmed the presence of a severe axonotmesis lesion of the radial, median, and ulnar nerves bilaterally. The patient was treated with static cock-up wrist splinting and discontinuation of the axillary crutches. Return of sensory and motor function was delayed but occurred within 9 months.
Raikin
S
S
Department of Orthopaedic Surgery, Mount Sinai Medical Center, Cleveland, Ohio, USA.
Froimson
M I
MI
D000328:Adult; D001917:Brachial Plexus / Q000293:injuries*; D003446:Crutches / Q000009:adverse effects*; D004576:Electromyography; D005270:Femur Head / Q000293:injuries*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013165:Splints