Ulnar stress reaction in an axillary crutch user

Abstract

Ulnar stress fractures have been reported in athletes performing repetitive, high-impact activities, such as baseball pitchers and gymnasts. Crutch-assisted walking also results in cyclical forearm loading. We report the first case of ulnar stress reaction due to axillary crutch use. A 23-year-old right-handed woman experienced right forearm pain and imaging confirmed a right ulnar stress injury. The patient was also found to have mild hypercortisolism, low bone mass and vitamin D deficiency. Crutches were discontinued and physical therapy to normalise weight bearing through the left leg was prescribed. The patient’s right forearm symptoms resolved and she was started on oral vitamin D supplementation. Axillary crutch use may result in ulnar stress injury, particularly in vulnerable populations. The addition of an upper extremity injury to someone with impaired mobility may compound disability. As such, clinicians should be aware of the clinical presentation of ulnar stress fractures in the long-term axillary crutch user.

The effect of axillary crutch length on upper limb kinematics during swing‐through gait

“…There have been case reports of ulnar stress fractures with walking aids (5 with forearm crutches, 1 with axillary crutches, 6 and 1 with a cane 39 ). These were thought to arise partially due to increased ulnar deviation at the wrist.…”

“…There have been case reports of ulnar stress fractures with walking aids (5 with forearm crutches, 1 with axillary crutches, 6 and 1 with a cane 39 ). These were thought to arise partially due to increased ulnar deviation at the In our investigation, however, the largest differences were observed for the short versus standard fit crutches, where the shorter crutches resulted in up to 6.6 greater radial deviation.…”

“…In a gait laboratory study, all 42 able‐bodied women using axillary crutches reported upper limb discomfort including cramping and paresthesiae 5 . In addition, upper limb stress fractures, aneurysms, and nerve injuries related to crutch use have been reported 3,6 . Appropriate crutch fitting has been identified from a review of clinical literature as an important consideration to mitigate potential risk of upper limb pain or injury with axillary crutch use 3,7 .…”

“…5 In addition, upper limb stress fractures, aneurysms, and nerve injuries related to crutch use have been reported. 3,6 Appropriate crutch fitting has been identified from a review of clinical literature as an important consideration to mitigate potential risk of upper limb pain or injury with axillary crutch use. 3,7 Axillary crutches that are too long may result in a sevenfold increase in force at the axilla.…”

Vitamin D and Stress Fractures in Sport: Preventive and Therapeutic Measures—A Narrative Review

“…Apart from the rather frequent locations, stress fractures can also occur in rare locations [ 125 , 126 , 127 ]. A rare location for a stress fracture on the lower extremity is the pelvis [ 113 , 126 ], the patella [ 128 , 129 ] and the femoral neck [ 127 ] and on the upper body the upper arm [ 130 , 131 ]. In rare cases, also stress fractures of the sacrum can occur [ 132 , 133 ].…”