Bilateral brachial plexus compressive neuropathy (crutch palsy)

Area of Science:

• Neurology
• Orthopedics
• Physical Medicine and Rehabilitation

Background:

• Brachial plexus compressive neuropathy, or crutch palsy, is a rare complication associated with axillary crutch use.
• While typically affecting children and resolving spontaneously, adult cases and severe presentations are less common.

Observation:

• A 36-year-old male developed bilateral posterior cord brachial plexus neuropathy, primarily affecting the radial nerve, after using axillary crutches for a femoral fracture.
• The patient exhibited minimal clinical improvement after 8 weeks, with electromyography confirming severe axonotmesis of the radial, median, and ulnar nerves.

Findings:

• Conservative management, including discontinuation of axillary crutches and wrist splinting, was initiated.
• Despite initial lack of improvement, the patient experienced a delayed but complete return of sensory and motor function within 9 months.

Implications:

• This case underscores that severe brachial plexus compressive neuropathy can occur in adults using axillary crutches.
• It suggests that even in severe cases with delayed presentation, functional recovery is possible with appropriate management and sufficient time.
• Highlights the importance of recognizing and managing crutch palsy in adult populations to prevent long-term disability.