Anterior interosseous nerve palsy following the use of elbow crutches

Wu, Feiran; Ismaeel, Adil; Siddiqi, Rehan

doi:10.4297/najms.2011.3296

Cited by 12 publications

(11 citation statements)

References 11 publications

(10 reference statements)

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“…Forearm crutches are also known as ‘elbow crutches’. To the best of our knowledge, there is only one reported case of AIN palsy following forearm crutch use;5 although the diagnosis was made only clinically and without the use of nerve conduction studies.…”

Section: Discussionmentioning

confidence: 99%

“…Electrodiagnostic studies comprising nerve conduction studies or electromyography (EMG) are considered the gold standard diagnostic test to confirm the clinical diagnosis of AIN and exclude tendon rupture 2 5. Imaging in the way of MRI or US scan may be considered to assess for tendon rupture, although it does not confirm or guide management of AIN lesions 16…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there is controversy around whether compressive injuries (as in this case) result in a transient neuritis which is best managed conservatively or whether a nerve entrapment plays a role; with a requirement for surgical decompression 2 3. All groups advocate conservative management initially, which usually comprises rest, removal of compressive precipitants and use of anti-inflammatories 3 5. However, the recommended time prior to surgical decompression for persisting paralysis ranges from 8 weeks to 2 years 6 17…”

Section: Discussionmentioning

confidence: 99%

“…Although palsy of the axillary nerve,21 ulnar nerve,22 radial nerve23 and brachial plexus24 has followed axillary crutch use, forearm crutch use has only been reported to cause ulnar nerve palsy,25 and a single case of AIN palsy 5. Novel crutch designs seek to spread the user’s weight over a greater surface area, reducing discomfort and potential damage to structures 26.…”

Section: Discussionmentioning

confidence: 99%

“…It passes distally under the pronator teres, and then between the flexor digitorum profundus (FDP) and the flexor pollicis longus (FPL), before travelling along the anterior interosseous membrane to the wrist 2–4. The AIN supplies the deep flexor compartment of the forearm, comprising pronator quadratus (PQ), FPL and the FDP tendon of the index and occasionally the middle finger 5 6. Clinically, the nerve palsy manifests with a characteristic inability to pinch with the tips of the index finger and thumb; known as the Kiloh-Nevin sign 3…”

Section: Introductionmentioning

confidence: 99%

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Persistent anterior interosseous nerve palsy following forearm crutch use

Macneal¹,

Crome

McNally

2017

BMJ Case Reports

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A 43-year-old man presented with weakness of the interphalageal joint of his right thumb following the use of forearm crutches. On examination he was unable to oppose his thumb and index finger to form the 'ok' sign. Nerve conduction showed anterior interosseous nerve (AIN) damage along its path to the flexor pollicis longus. The patient was managed conservatively with little clinical improvement seen at 4 months. AIN palsies are very rare and account for <1% of all upper limb lesions. Although AIN palsies resulting from other causes such as surgery and blunt trauma are more common, we report the second case of AIN palsy following crutch use, and the first case in which clinical identification was confirmed using electrodiagnosis. Usual clinical practice recommends a prolonged period of conservative management with surgical management withheld for a minimum of 12 months. Correct crutch fitting and early identification of signs of associated injuries are of paramount importance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Persistent anterior interosseous nerve palsy following forearm crutch use

Macneal¹,

Crome

McNally

2017

BMJ Case Reports

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Injuries Associated with Crutch Use: A Narrative Review

Manocha

MacGillivray

Eshraghi

et al. 2020

PM&R

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Crutches are commonly prescribed in physiatric settings to help offload the lower extremities. Crutch use, however, results in abnormal and repetitive weight-bearing through the upper extremities that may result in secondary injury. This narrative review investigates injury types and risk factors associated with crutch use in order to guide healthcare providers on injury prevention strategies. Medline, EMBASE, CINAHL, and the Cochrane Library were systematically reviewed for publications between 1950 and 2018 on neurological, musculoskeletal, or vascular complications associated with crutch use. Titles and abstracts (n = 2395) were screened by two authors. Sixty studies were eligible. Articles were reviewed for level of evidence, crutch type, participant characteristics, and injury characteristics. There were 42 axillary crutch studies, 12 forearm crutch studies, and 6 studies that did not specify crutch type. These studies incorporated 622 individuals, and most were case series or case reports (n = 54). Axillary crutch use was most commonly associated with axillobrachial arterial complications due to pressure from the axillary bar (n = 34). Forearm crutch use was most commonly associated with compressive neuropathies due to pressure from the forearm cuff (n = 6). Improper crutch fitting and/or use were identified as contributing factors to injury in 22 cases. Duration of crutch use and medical comorbidities also influenced the types of injuries seen. There are rare but potentially serious complications associated with crutch use. When prescribing crutches, clinicians should ensure they are properly fit, engage in appropriate gait training, be aware of common crutch-related injuries, and consider potential patient-specific injury risk factors in order to minimize injury risk.

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Locating the anterior interosseous nerve in relation to the surgically relevant landmarks of the forearm: A cadaveric study

Ankolekar

Hosapatna

D’Souza

2021

Annals of Medicine and Surgery

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Background This study emphasizes locating the anterior interosseous nerve (AIN) related to its level of origin, number, and lengths of its muscular branches and relation to surgically important landmarks such as the bi-epicondylar line, pronator teres, and Gantzer muscles. Methods The study was undertaken at a private Medical school in south India during 2019–20. The level of origin of AIN was measured from the bi-epicondylar line and its length was measured up to the upper border of the pronator quadratus using 44 cadaveric upper limbs. The number of branches given to flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) was quantified and their lengths were measured. Results The nerve originated at a mean distance of 41.56 mm from the bi-epicondylar line. In 12 upper limbs, FDP received two branches and in two limbs, it received three branches. In 13 upper limbs, FPL received two branches from AIN. It was observed that the muscular branches for FDP were shorter than those for FPL. Gantzer muscle was observed in 18 (40%) specimens and was found superficial to the nerve. Conclusion The muscular branches of AIN had a variable pattern of innervation. Multiple muscular branches to the FPL and FDP were observed in the upper 2/3rds of the forearm. These branches to FPL and FDP would aid as a source of nerve grafting and nerve transfer in the cases of upper extremity nerve palsies.

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Anterior interosseous nerve palsy following the use of elbow crutches

Cited by 12 publications

References 11 publications

Persistent anterior interosseous nerve palsy following forearm crutch use

Persistent anterior interosseous nerve palsy following forearm crutch use

Injuries Associated with Crutch Use: A Narrative Review

Locating the anterior interosseous nerve in relation to the surgically relevant landmarks of the forearm: A cadaveric study

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