Background: Axillary crutches are commonly used in rehabilitation. Inappropriately fit crutches may result in upper limb pain or injury. Objective: To investigate the effects of axillary crutch length on upper limb kinematics to better understand potential injury mechanisms. It was hypothesized that crutches that were longer or shorter than standard-fit crutches would alter upper limb kinematics. Design: Cross-sectional. Setting: Gait laboratory. Participants: Fifteen healthy males with no prior crutch experience. Interventions: Participants were fit with axillary crutches using standardized methods, as well as with crutches that were 5 cm longer and 5 cm shorter. Participants performed swing-through gait (1.20 AE 0.07 ms À1 ) with all crutch lengths in randomized order. Kinematics were recorded using an optical motion-tracking system and joint angles for the scapula, shoulder, elbow, and wrist were computed. Main Outcome Measures: The effects of crutch length on joint range of motion (ROM) and joint angles at initial crutch contact were analyzed using multivariate analysis (Hotelling's T 2 ; α = .025) and simultaneous confidence intervals (CI). Results: The long-standard crutch fit comparison showed effects across all joints (ROM p = .009; initial contact p < .001). Longer crutches resulted in greater scapular upward rotation (mean difference [95% CI] ROM: 1.0 [À0.2 to 2.2]; initial contact: À2.7 [À4.4, À1.1]) and shoulder abduction (ROM: 0.8 [À0.1 to 1.8]; initial contact: À1.9 [À4.1 to 0.3]). Crutch length also had effects across all joints for the short-standard fit comparison (ROM p = .004; initial contact p = .016). Shorter crutches resulted in greater scapula downward rotation (2.2 [À0.4 to 4.8]) and greater shoulder adduction (2.5 [À0.6 to 5.6]) at initial contact. Shorter crutches also reduced shoulder flexion/extension ROM (À2.5 [À4.4 to À0.6]). Conclusions: Altered crutch length results in scapular and shoulder kinematic deviations that may present risk factors for upper limb injury with crutch-walking. This may underline the importance of appropriate device fitting to reduce injury risk in crutch users.
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