Crutch paralysis

Crutch paralysis is a medical condition characterized by damage to the peripheral nerves, specifically the radial nerve, caused by prolonged pressure on the nerve during the use of crutches. This condition is also known as crutch palsy or Saturday night palsy, when it occurs due to other causes of radial nerve compression. The radial nerve is responsible for controlling the movement and sensation in the arm and hand, making crutch paralysis a significant concern for individuals relying on crutches for mobility.

Causes

The primary cause of crutch paralysis is the improper use or fitting of crutches, where excessive pressure is placed on the underarm (axilla), compressing the radial nerve against the humerus. This can occur when crutches are too tall, forcing the user to lean on the top pads, or when the user's weight is not properly distributed through the hands. Other causes include prolonged immobilization, direct trauma to the nerve, and compression from sleeping or lying in a position that puts pressure on the nerve.

Symptoms

Symptoms of crutch paralysis can vary depending on the severity of the nerve damage but typically include:

• Weakness in the wrist and hand, leading to a condition known as wrist drop, where the individual is unable to lift the wrist or fingers.
• Numbness, tingling, or loss of sensation in the back of the hand and fingers.
• Difficulty with finger coordination and tasks requiring fine motor skills.

Diagnosis

Diagnosis of crutch paralysis involves a thorough medical history and physical examination, focusing on the use of crutches and the presence of symptoms. Additional tests may include:

• Electromyography (EMG) and nerve conduction studies to assess the electrical activity of muscles and the speed of nerve signal transmission.
• Imaging studies, such as MRI or ultrasound, to visualize the nerve and surrounding structures for any signs of compression or damage.

Treatment

Treatment for crutch paralysis primarily aims at relieving the pressure on the radial nerve and allowing it to heal. This may involve:

• Adjusting the fit and use of crutches to ensure proper weight distribution and reduce pressure on the underarm.
• Physical therapy to maintain muscle strength and flexibility, and to encourage nerve regeneration.
• Occupational therapy to assist with daily activities and adaptive techniques.
• In severe cases, surgery may be required to decompress the nerve or repair nerve damage.

Prevention

Preventing crutch paralysis involves proper selection, fitting, and use of crutches:

• Ensure crutches are the correct height, allowing for a slight bend in the elbow when the hands are on the grips.
• Teach and reinforce the importance of distributing weight through the hands rather than the underarms.
• Regularly check and adjust crutch pads and hand grips for wear and tear.

See Also

• Peripheral neuropathy
• Nerve compression syndrome
• Rehabilitation medicine

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