Secondary Bilateral Compressive Radial Nerve Injury Induced by Crutch Use: A Case Report

Secondary Bilateral Compressive Radial Nerve Injury Induced by Crutch Use: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Secondary Bilateral Compressive Radial Nerve Injury Induced by Crutch Use: A Case Report Xian Guo, Wanchao Ding, Mingtian Cao, Zehua Wang, Yin Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8395889/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Secondary radial nerve injury caused by crutch use is relatively uncommon in clinical practice, and simultaneous bilateral involvement is even rarer. Such injuries are easily overlooked in the early stage, particularly among patients who require long-term assisted ambulation following lower-limb surgery. Reporting such cases helps raise clinical awareness of peripheral nerve injuries associated with assistive devices and contributes to the optimization of diagnostic and preventive strategies. Case presentation: The patient was a 54-year-old man who developed progressive bilateral weakness of wrist and finger extension after prolonged crutch-assisted ambulation following lower-limb fracture surgery. Physical examination revealed bilateral “wrist drop” and “finger drop” deformities, with extensor muscle strength of the wrist and metacarpophalangeal joints graded as M1, while muscle strength of the shoulder and elbow joints was normal. Cervical MRI showed no evidence of nerve root or spinal cord compression, and electromyography confirmed bilateral radial nerve injury. Comprehensive conservative management was initiated, including discontinuation of crutch use, functional-position wrist immobilization, and adjunctive therapy with glucocorticoids, neurotrophic agents, physical therapy, and hyperbaric oxygen therapy. After 2 weeks of treatment, extensor muscle strength of the left wrist and metacarpophalangeal joints improved to M3, while the right side recovered to M2. At the 2-month follow-up, further improvement was observed, with recovery to M4 on the left side and M3 on the right side. Conclusions Prolonged improper use of crutches may result in compressive radial nerve injury, and the early clinical manifestations are often easily overlooked. Careful acquisition of a detailed medical history combined with electrophysiological evaluation is essential for establishing an accurate diagnosis and improving patient outcomes. In addition, greater emphasis should be placed on educating patients about the proper use of walking aids in order to reduce the risk of secondary peripheral nerve injuries. Crutch use Radial nerve injury Bilateral paralysis Compressive neuropathy Figures Figure 1 Figure 2 1. Introduction Closed radial nerve injury is relatively common in clinical practice and typically presents with unilateral involvement. The most frequent etiologies include fractures of the middle to distal radius and prolonged local compression of the upper limb [ 1 ] . However, when the causative factors are atypical or when concomitant imaging abnormalities are present, accurate identification of the lesion site and underlying etiology may be clinically challenging [ 2 ] . Radial nerve injury secondary to crutch use is uncommon, and simultaneous bilateral involvement is particularly rare [ 3 ] . Herein, we report a case of bilateral radial nerve injury secondary to long-term crutch use that was recently treated in our department. 2. Case report The patient was a 54-year-old man who was admitted with a 2-week history of bilateral weakness and restricted movement in wrist and finger extension. His medical history was notable for an open reduction and internal fixation for a right calcaneal fracture performed at another hospital 3 months earlier. Two months after surgery, he began ambulating with bilateral crutch assistance. Physical examination revealed typical bilateral “wrist drop” and “finger drop” deformities. The muscle strength of wrist and metacarpophalangeal joint extension was graded as M1 bilaterally, whereas shoulder and elbow muscle strength was preserved at M5. Deep and superficial sensation in both upper limbs was intact (Fig. 1A). Auxiliary examinations showed no definite evidence of nerve root or spinal cord compression on cervical magnetic resonance imaging (MRI) (Fig. 2). Electromyography and nerve conduction studies demonstrated bilateral radial nerve injury. Based on the clear history of crutch use, the characteristic pure motor deficits, and the electrophysiological localization findings, central and radiculopathic lesions were excluded. The patient was therefore diagnosed with bilateral radial nerve injury and status post open reduction and internal fixation of a right calcaneal fracture. After admission, based on the patient’s medical history and clinical manifestations, the neurological dysfunction was considered likely related to sustained external compression. The patient was therefore immediately instructed to discontinue ambulation with bilateral crutches to relieve the potential continuous compressive stress on the radial nerves. Meanwhile, functional-position splinting of both wrists and fingers was applied to prevent secondary flexion contractures and to provide a favorable biomechanical environment for neural recovery. Pharmacological treatment aimed at anti-inflammatory effects and reduction of neural edema, including intravenous dexamethasone sodium phosphate (10 mg). Mannitol (125 mL) was administered intravenously twice daily to reduce nerve edema and improve local microcirculation. Neurotrophic and metabolic support therapy was also provided, including oral mecobalamin (0.5 mg, three times daily) and aescin (300 mg, twice daily). To prevent glucocorticoid-related gastrointestinal adverse effects, omeprazole was prescribed for gastric mucosal protection. In addition, the patient received multidisciplinary comprehensive management. Following consultation with the hyperbaric medicine department, hyperbaric oxygen therapy was initiated in a monoplace chamber with 100% oxygen at a pressure of 2.1 ATA for 90 minutes once daily, with a planned course of 10–20 sessions. After consultation with the rehabilitation department, physical therapy and functional training were implemented, including occupational therapy, hand function training, low-frequency electrical stimulation, and manual therapy for small joint dysfunction. After 2 weeks of comprehensive treatment, the patient showed marked improvement in bilateral wrist and finger extension. The patient was discharged in stable condition. At discharge, physical examination revealed recovery of left wrist and metacarpophalangeal joint extension strength to M3, while right wrist extension strength was close to M3 and metacarpophalangeal joint extension strength reached M3 (Fig. 1B); distal circulation and sensation of both upper limbs were normal. At the 2-month follow-up, extension strength of the left wrist and metacarpophalangeal joints further improved to M4, whereas the right wrist and metacarpophalangeal joint extension strength recovered to M3. 3. Discussion The radial nerve is the longest and thickest branch of the brachial plexus. Owing to its extensive course and close anatomical relationship with multiple bony structures, muscle groups, and tendinous tissues, it is particularly vulnerable to injury under conditions of trauma or sustained local compression, making it one of the most commonly affected peripheral nerves in clinical practice. Radial nerve injury most frequently occurs secondary to humeral fractures or prolonged local compression and typically presents with the characteristic deformities of “wrist drop” and “finger drop” [ 4 ] . Axillary crutches are commonly used as a simple assistive device during postoperative rehabilitation after lower limb injuries and usually require weight bearing through both the axillae and upper limbs. Improper use, however, may result in various complications, among which brachial plexus injury is the most frequently reported [ 5 ]–[ 7 ] . In contrast, isolated radial nerve injury caused solely by axillary crutch use has rarely been reported, and bilateral involvement is exceedingly uncommon [ 3 ] . Previous studies have demonstrated that inappropriate crutch use can damage the radial nerve through multiple mechanisms. These primarily include prolonged maintenance of specific upper limb postures, leading to sustained compression of the radial nerve by the forearm extensor muscles and surrounding ligaments, accompanied by a degree of neural traction. Such adverse biomechanical effects are particularly pronounced when the crutches are adjusted to an insufficient length [ 8 ],[ 9 ] . In addition, individual anatomical variations or underlying developmental abnormalities may serve as predisposing factors. In the present case, the patient was right-handed and had a concomitant right calcaneal fracture, suggesting that the more severe involvement of the right radial nerve may have been related to habitual use patterns and asymmetric weight bearing. The diagnosis and management of peripheral neuropathies often present significant clinical challenges [ 10 ] , especially in the presence of confounding factors such as degenerative changes on cervical imaging. Differentiating central or radiculopathic lesions from peripheral nerve injury is critical for establishing an appropriate treatment strategy. Although cervical degenerative changes were noted in this patient, the clinical presentation was characterized by a pure motor deficit, with preserved superficial and deep sensation in both upper limbs and no abnormalities in tendon reflexes or long tract signs. These findings were inconsistent with typical cervical radiculopathy or spinal cord pathology. Electrophysiological studies played a decisive role in lesion localization in this case. Nerve conduction studies and electromyography clearly localized the pathology to the peripheral nerve level, thereby excluding involvement of the nerve roots or central nervous system. Previous reports have indicated that compressive neuropathies are a common cause of peripheral sensory disturbances and muscle weakness. Comprehensive clinical evaluation remains essential for diagnosis, while electromyography and nerve conduction studies are still considered the first-line ancillary tools for lesion localization and severity assessment. Magnetic resonance imaging is also playing an increasingly important complementary role in the visualization of neuropathological changes [ 11 ],[ 12 ] . With regard to treatment, closed radial nerve injuries not associated with fractures are most often incomplete, and the majority of patients can achieve satisfactory functional recovery within approximately three months with standardized conservative management [ 4 ] . Common conservative measures include activity modification, functional-position splinting, nerve gliding exercises, corticosteroid injections, anti-inflammatory therapy, and vitamin supplementation. Surgical decompression or nerve reconstruction should be considered for patients with persistent symptoms or those with associated open injuries [ 4 ],[ 11 ],[ 13 ] . Regardless of the treatment modality, preservation of local vascular supply and maintenance of neural mobility are key factors in promoting nerve regeneration and optimizing functional outcomes [ 14 ] . This case report is limited by its single-case design, which restricts the generalizability of the findings to broader populations. In addition, the relatively short follow-up period precludes a comprehensive assessment of long-term neurological recovery and potential delayed residual deficits. Despite these limitations, this case highlights that improper use of walking aids may represent a rare etiological factor for radial nerve injury, underscoring the importance of individualized evaluation and management, and providing valuable clinical insights for early recognition, prevention, and standardized guidance in the management of related peripheral nerve injuries. 4. Conclusion Secondary bilateral radial nerve injury caused by crutch use is exceedingly rare, and its early clinical manifestations are often subtle, making misdiagnosis or delayed diagnosis likely. Such delays may result in missed opportunities for timely intervention and can even lead to irreversible neurological deficits, warranting a high level of clinical vigilance. Prevention of this type of injury mainly involves two key aspects: first, strengthening patient education to ensure proper and standardized use of crutches; and second, selecting an appropriate type of crutch and adjusting it to a suitable height based on the patient’s body habitus and functional status. In addition, if patients develop symptoms such as upper limb numbness, weakness, or restricted movement during crutch use, prompt medical evaluation is essential to facilitate early recognition and intervention, thereby minimizing the risk of adverse outcomes. This case underscores that, in addition to standardized treatment, healthcare professionals should place greater emphasis on guidance and supervision regarding the use of walking aids to reduce the occurrence of such rare but potentially severe peripheral nerve injuries. Declarations Disclosure statement This manuscript is entirely original, and neither the article nor any portion of its content has been previously published or is under consideration for publication elsewhere. The authors declare that they have no conflicts of interest. Author Contributions GX contributed to the conceptualization and drafting of the manuscript. DWC, CMT, and WZH were responsible for literature search, collection, and data organization. YY critically revised the manuscript and acted as the corresponding author. All authors made substantial contributions to the study, reviewed the manuscript, and approved the final version for submission. Ethical approval This study was approved by the Ethics Committee of Xi’an Central Hospital. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The patient was informed that all reasonable efforts would be made to ensure anonymity while preserving scientific integrity. Consent for publication All authors have provided their consent for the publication of this manuscript. Data availability The data supporting the findings of this study are available. Funding This work was funded by the Key Research and Development Program of Shaanxi Province [Grant No. 2023-YBSF-655]. The funder had no role in study design, data collection, analysis, publication decisions, or manuscript preparation. Declaration of Competing Interest The authors declare that there are no known competing financial interests or personal relationships that could be perceived as influencing the work reported in this study. Acknowledgements We gratefully acknowledge the anonymous reviewers for their insightful and constructive feedback, which substantially contributed to the refinement and enhancement of this manuscript. References Vij N, Kiernan H, Miller-Gutierrez S, et al. Etiology Diagnosis and Management of Radial Nerve Entrapment[J]. Anesthesiology and Pain Medicine, 2021, 11(1): e112823. Węgiel A, Karauda P, Zielinska N, et al. Radial nerve compression: anatomical perspective and clinical consequences[J]. Neurosurgical Review, 2023, 46(1): 53. Düz B, Solmaz Ï, Civelek E, et al. Analysis of proximal radial nerve injury in the arm[J]. Neurology India, 2010, 58(2): 230. Bumbasirevic M, Palibrk T, Lesic A, et al. Radial nerve palsy[J]. EFORT Open Reviews, 2016, 1(8): 286-294. Méndez-Gómez D D, Minor-Martínez A, Montoya-Alvarez S, et al. Prototype of a Spring-Loaded Module for Axillary Crutches[J]. Sensors (Basel, Switzerland), 2025, 25(2): 296. da Costa D L L, Felipe G, Borges M A P. Aneurismas da artéria e da veia braquial induzidos por uso contínuo de muleta: relato de caso[J]. Jornal Vascular Brasileiro, 2017, 16(4): 325-328. Furukawa K, Hayase T, Yano M. Recurrent upper limb ischaemia due to a crutch-induced brachial artery aneurysm[J]. Interactive Cardiovascular and Thoracic Surgery, 2013, 17(1): 190-192. Kimbrough D A, Mehta K, Wissman R D. Case of the Season: Saturday Night Palsy[J]. Seminars in Roentgenology, 2013, 48(2): 108-110. Jajeh H, Lee A, Charls R, et al. A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies[J]. Journal of Spine Surgery, 2024, 10(1): 120-134. Moritz T. Nerves and neuropathies of the upper limb[J]. Ultrasound in Medicine & Biology, 2019, 45: S37. Cornely R M, Henry A, Johnson J, et al. Compressive Neuropathy in the Upper Extremity: Pathophysiology, Diagnosis, and Treatment[J]. Annals of Plastic Surgery, 2025, 95(3S): S60. Doughty C T, Bowley M P. Entrapment Neuropathies of the Upper Extremity[J]. The Medical Clinics of North America, 2019, 103(2): 357-370. Gutama B, Popa N K, Byers V, et al. Peripheral Nerve Transfers: Core Principles and Workhorse Techniques[J]. Annals of Plastic Surgery, 2025, 94(6S Suppl 4): S555-S558. Cavalcanti Kußmaul A, Hermann W, Boever J, et al. Nerve compression syndromes of the median and radial nerves at the elbow[J]. Orthopadie (Heidelberg, Germany), 2025, 54(4): 309-320. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8395889","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":565212203,"identity":"4cf20012-8944-42ae-9202-ccc6a5f47b8f","order_by":0,"name":"Xian Guo","email":"","orcid":"","institution":"Shaanxi University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Xian","middleName":"","lastName":"Guo","suffix":""},{"id":565212204,"identity":"93d4d0b9-59c2-493c-9f61-fd86a9ab3cdf","order_by":1,"name":"Wanchao Ding","email":"","orcid":"","institution":"Shaanxi University of Chinese 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Introduction","content":"\u003cp\u003eClosed radial nerve injury is relatively common in clinical practice and typically presents with unilateral involvement. The most frequent etiologies include fractures of the middle to distal radius and prolonged local compression of the upper limb\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. However, when the causative factors are atypical or when concomitant imaging abnormalities are present, accurate identification of the lesion site and underlying etiology may be clinically challenging\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Radial nerve injury secondary to crutch use is uncommon, and simultaneous bilateral involvement is particularly rare\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Herein, we report a case of bilateral radial nerve injury secondary to long-term crutch use that was recently treated in our department.\u003c/p\u003e"},{"header":"2. Case report","content":"\u003cp\u003eThe patient was a 54-year-old man who was admitted with a 2-week history of bilateral weakness and restricted movement in wrist and finger extension. His medical history was notable for an open reduction and internal fixation for a right calcaneal fracture performed at another hospital 3 months earlier. Two months after surgery, he began ambulating with bilateral crutch assistance.\u003c/p\u003e \u003cp\u003ePhysical examination revealed typical bilateral \u0026ldquo;wrist drop\u0026rdquo; and \u0026ldquo;finger drop\u0026rdquo; deformities. The muscle strength of wrist and metacarpophalangeal joint extension was graded as M1 bilaterally, whereas shoulder and elbow muscle strength was preserved at M5. Deep and superficial sensation in both upper limbs was intact (Fig.\u0026nbsp;1A).\u003c/p\u003e \u003cp\u003eAuxiliary examinations showed no definite evidence of nerve root or spinal cord compression on cervical magnetic resonance imaging (MRI) (Fig.\u0026nbsp;2). Electromyography and nerve conduction studies demonstrated bilateral radial nerve injury. Based on the clear history of crutch use, the characteristic pure motor deficits, and the electrophysiological localization findings, central and radiculopathic lesions were excluded. The patient was therefore diagnosed with bilateral radial nerve injury and status post open reduction and internal fixation of a right calcaneal fracture.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAfter admission, based on the patient\u0026rsquo;s medical history and clinical manifestations, the neurological dysfunction was considered likely related to sustained external compression. The patient was therefore immediately instructed to discontinue ambulation with bilateral crutches to relieve the potential continuous compressive stress on the radial nerves. Meanwhile, functional-position splinting of both wrists and fingers was applied to prevent secondary flexion contractures and to provide a favorable biomechanical environment for neural recovery.\u003c/p\u003e \u003cp\u003ePharmacological treatment aimed at anti-inflammatory effects and reduction of neural edema, including intravenous dexamethasone sodium phosphate (10 mg). Mannitol (125 mL) was administered intravenously twice daily to reduce nerve edema and improve local microcirculation. Neurotrophic and metabolic support therapy was also provided, including oral mecobalamin (0.5 mg, three times daily) and aescin (300 mg, twice daily). To prevent glucocorticoid-related gastrointestinal adverse effects, omeprazole was prescribed for gastric mucosal protection.\u003c/p\u003e \u003cp\u003eIn addition, the patient received multidisciplinary comprehensive management. Following consultation with the hyperbaric medicine department, hyperbaric oxygen therapy was initiated in a monoplace chamber with 100% oxygen at a pressure of 2.1 ATA for 90 minutes once daily, with a planned course of 10\u0026ndash;20 sessions. After consultation with the rehabilitation department, physical therapy and functional training were implemented, including occupational therapy, hand function training, low-frequency electrical stimulation, and manual therapy for small joint dysfunction.\u003c/p\u003e \u003cp\u003eAfter 2 weeks of comprehensive treatment, the patient showed marked improvement in bilateral wrist and finger extension. The patient was discharged in stable condition. At discharge, physical examination revealed recovery of left wrist and metacarpophalangeal joint extension strength to M3, while right wrist extension strength was close to M3 and metacarpophalangeal joint extension strength reached M3 (Fig.\u0026nbsp;1B); distal circulation and sensation of both upper limbs were normal. At the 2-month follow-up, extension strength of the left wrist and metacarpophalangeal joints further improved to M4, whereas the right wrist and metacarpophalangeal joint extension strength recovered to M3.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eThe radial nerve is the longest and thickest branch of the brachial plexus. Owing to its extensive course and close anatomical relationship with multiple bony structures, muscle groups, and tendinous tissues, it is particularly vulnerable to injury under conditions of trauma or sustained local compression, making it one of the most commonly affected peripheral nerves in clinical practice. Radial nerve injury most frequently occurs secondary to humeral fractures or prolonged local compression and typically presents with the characteristic deformities of \u0026ldquo;wrist drop\u0026rdquo; and \u0026ldquo;finger drop\u0026rdquo;\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAxillary crutches are commonly used as a simple assistive device during postoperative rehabilitation after lower limb injuries and usually require weight bearing through both the axillae and upper limbs. Improper use, however, may result in various complications, among which brachial plexus injury is the most frequently reported\u003csup\u003e[\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. In contrast, isolated radial nerve injury caused solely by axillary crutch use has rarely been reported, and bilateral involvement is exceedingly uncommon\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Previous studies have demonstrated that inappropriate crutch use can damage the radial nerve through multiple mechanisms. These primarily include prolonged maintenance of specific upper limb postures, leading to sustained compression of the radial nerve by the forearm extensor muscles and surrounding ligaments, accompanied by a degree of neural traction. Such adverse biomechanical effects are particularly pronounced when the crutches are adjusted to an insufficient length\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e],[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In addition, individual anatomical variations or underlying developmental abnormalities may serve as predisposing factors. In the present case, the patient was right-handed and had a concomitant right calcaneal fracture, suggesting that the more severe involvement of the right radial nerve may have been related to habitual use patterns and asymmetric weight bearing.\u003c/p\u003e \u003cp\u003eThe diagnosis and management of peripheral neuropathies often present significant clinical challenges\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, especially in the presence of confounding factors such as degenerative changes on cervical imaging. Differentiating central or radiculopathic lesions from peripheral nerve injury is critical for establishing an appropriate treatment strategy. Although cervical degenerative changes were noted in this patient, the clinical presentation was characterized by a pure motor deficit, with preserved superficial and deep sensation in both upper limbs and no abnormalities in tendon reflexes or long tract signs. These findings were inconsistent with typical cervical radiculopathy or spinal cord pathology. Electrophysiological studies played a decisive role in lesion localization in this case. Nerve conduction studies and electromyography clearly localized the pathology to the peripheral nerve level, thereby excluding involvement of the nerve roots or central nervous system. Previous reports have indicated that compressive neuropathies are a common cause of peripheral sensory disturbances and muscle weakness. Comprehensive clinical evaluation remains essential for diagnosis, while electromyography and nerve conduction studies are still considered the first-line ancillary tools for lesion localization and severity assessment. Magnetic resonance imaging is also playing an increasingly important complementary role in the visualization of neuropathological changes\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e],[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWith regard to treatment, closed radial nerve injuries not associated with fractures are most often incomplete, and the majority of patients can achieve satisfactory functional recovery within approximately three months with standardized conservative management\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Common conservative measures include activity modification, functional-position splinting, nerve gliding exercises, corticosteroid injections, anti-inflammatory therapy, and vitamin supplementation. Surgical decompression or nerve reconstruction should be considered for patients with persistent symptoms or those with associated open injuries\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e],[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e],[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Regardless of the treatment modality, preservation of local vascular supply and maintenance of neural mobility are key factors in promoting nerve regeneration and optimizing functional outcomes\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis case report is limited by its single-case design, which restricts the generalizability of the findings to broader populations. In addition, the relatively short follow-up period precludes a comprehensive assessment of long-term neurological recovery and potential delayed residual deficits. Despite these limitations, this case highlights that improper use of walking aids may represent a rare etiological factor for radial nerve injury, underscoring the importance of individualized evaluation and management, and providing valuable clinical insights for early recognition, prevention, and standardized guidance in the management of related peripheral nerve injuries.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eSecondary bilateral radial nerve injury caused by crutch use is exceedingly rare, and its early clinical manifestations are often subtle, making misdiagnosis or delayed diagnosis likely. Such delays may result in missed opportunities for timely intervention and can even lead to irreversible neurological deficits, warranting a high level of clinical vigilance. Prevention of this type of injury mainly involves two key aspects: first, strengthening patient education to ensure proper and standardized use of crutches; and second, selecting an appropriate type of crutch and adjusting it to a suitable height based on the patient’s body habitus and functional status. In addition, if patients develop symptoms such as upper limb numbness, weakness, or restricted movement during crutch use, prompt medical evaluation is essential to facilitate early recognition and intervention, thereby minimizing the risk of adverse outcomes. This case underscores that, in addition to standardized treatment, healthcare professionals should place greater emphasis on guidance and supervision regarding the use of walking aids to reduce the occurrence of such rare but potentially severe peripheral nerve injuries.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript is entirely original, and neither the article nor any portion of its content has been previously published or is under consideration for publication elsewhere. The authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGX contributed to the conceptualization and drafting of the manuscript. DWC, CMT, and WZH were responsible for literature search, collection, and data organization. YY critically revised the manuscript and acted as the corresponding author. All authors made substantial contributions to the study, reviewed the manuscript, and approved the final version for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Xi’an Central Hospital. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The patient was informed that all reasonable efforts would be made to ensure anonymity while preserving scientific integrity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have provided their consent for the publication of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was funded by the Key Research and Development Program of Shaanxi Province [Grant No. 2023-YBSF-655]. The funder had no role in study design, data collection, analysis, publication decisions, or manuscript preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no known competing financial interests or personal relationships that could be perceived as influencing the work reported in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the anonymous reviewers for their insightful and constructive feedback, which substantially contributed to the refinement and enhancement of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eVij N, Kiernan H, Miller-Gutierrez S, et al. Etiology Diagnosis and Management of Radial Nerve Entrapment[J]. Anesthesiology and Pain Medicine, 2021, 11(1): e112823.\u003c/li\u003e\n\u003cli\u003eWęgiel A, Karauda P, Zielinska N, et al. Radial nerve compression: anatomical perspective and clinical consequences[J]. Neurosurgical Review, 2023, 46(1): 53.\u003c/li\u003e\n\u003cli\u003eD\u0026uuml;z B, Solmaz \u0026Iuml;, Civelek E, et al. Analysis of proximal radial nerve injury in the arm[J]. Neurology India, 2010, 58(2): 230.\u003c/li\u003e\n\u003cli\u003eBumbasirevic M, Palibrk T, Lesic A, et al. Radial nerve palsy[J]. EFORT Open Reviews, 2016, 1(8): 286-294.\u003c/li\u003e\n\u003cli\u003eM\u0026eacute;ndez-G\u0026oacute;mez D D, Minor-Mart\u0026iacute;nez A, Montoya-Alvarez S, et al. Prototype of a Spring-Loaded Module for Axillary Crutches[J]. Sensors (Basel, Switzerland), 2025, 25(2): 296.\u003c/li\u003e\n\u003cli\u003eda Costa D L L, Felipe G, Borges M A P. Aneurismas da art\u0026eacute;ria e da veia braquial induzidos por uso cont\u0026iacute;nuo de muleta: relato de caso[J]. Jornal Vascular Brasileiro, 2017, 16(4): 325-328.\u003c/li\u003e\n\u003cli\u003eFurukawa K, Hayase T, Yano M. Recurrent upper limb ischaemia due to a crutch-induced brachial artery aneurysm[J]. Interactive Cardiovascular and Thoracic Surgery, 2013, 17(1): 190-192.\u003c/li\u003e\n\u003cli\u003eKimbrough D A, Mehta K, Wissman R D. Case of the Season: Saturday Night Palsy[J]. Seminars in Roentgenology, 2013, 48(2): 108-110.\u003c/li\u003e\n\u003cli\u003eJajeh H, Lee A, Charls R, et al. A clinical review of hand manifestations of cervical myelopathy, cervical radiculopathy, radial, ulnar, and median nerve neuropathies[J]. Journal of Spine Surgery, 2024, 10(1): 120-134.\u003c/li\u003e\n\u003cli\u003eMoritz T. Nerves and neuropathies of the upper limb[J]. Ultrasound in Medicine \u0026amp; Biology, 2019, 45: S37.\u003c/li\u003e\n\u003cli\u003eCornely R M, Henry A, Johnson J, et al. Compressive Neuropathy in the Upper Extremity: Pathophysiology, Diagnosis, and Treatment[J]. Annals of Plastic Surgery, 2025, 95(3S): S60.\u003c/li\u003e\n\u003cli\u003eDoughty C T, Bowley M P. Entrapment Neuropathies of the Upper Extremity[J]. The Medical Clinics of North America, 2019, 103(2): 357-370.\u003c/li\u003e\n\u003cli\u003eGutama B, Popa N K, Byers V, et al. Peripheral Nerve Transfers: Core Principles and Workhorse Techniques[J]. Annals of Plastic Surgery, 2025, 94(6S Suppl 4): S555-S558.\u003c/li\u003e\n\u003cli\u003eCavalcanti Ku\u0026szlig;maul A, Hermann W, Boever J, et al. Nerve compression syndromes of the median and radial nerves at the elbow[J]. Orthopadie (Heidelberg, Germany), 2025, 54(4): 309-320.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Crutch use, Radial nerve injury, Bilateral paralysis, Compressive neuropathy","lastPublishedDoi":"10.21203/rs.3.rs-8395889/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8395889/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSecondary radial nerve injury caused by crutch use is relatively uncommon in clinical practice, and simultaneous bilateral involvement is even rarer. Such injuries are easily overlooked in the early stage, particularly among patients who require long-term assisted ambulation following lower-limb surgery. Reporting such cases helps raise clinical awareness of peripheral nerve injuries associated with assistive devices and contributes to the optimization of diagnostic and preventive strategies.\u003c/p\u003e\u003ch2\u003eCase presentation:\u003c/h2\u003e \u003cp\u003eThe patient was a 54-year-old man who developed progressive bilateral weakness of wrist and finger extension after prolonged crutch-assisted ambulation following lower-limb fracture surgery. Physical examination revealed bilateral \u0026ldquo;wrist drop\u0026rdquo; and \u0026ldquo;finger drop\u0026rdquo; deformities, with extensor muscle strength of the wrist and metacarpophalangeal joints graded as M1, while muscle strength of the shoulder and elbow joints was normal. Cervical MRI showed no evidence of nerve root or spinal cord compression, and electromyography confirmed bilateral radial nerve injury. Comprehensive conservative management was initiated, including discontinuation of crutch use, functional-position wrist immobilization, and adjunctive therapy with glucocorticoids, neurotrophic agents, physical therapy, and hyperbaric oxygen therapy. After 2 weeks of treatment, extensor muscle strength of the left wrist and metacarpophalangeal joints improved to M3, while the right side recovered to M2. At the 2-month follow-up, further improvement was observed, with recovery to M4 on the left side and M3 on the right side.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eProlonged improper use of crutches may result in compressive radial nerve injury, and the early clinical manifestations are often easily overlooked. Careful acquisition of a detailed medical history combined with electrophysiological evaluation is essential for establishing an accurate diagnosis and improving patient outcomes. In addition, greater emphasis should be placed on educating patients about the proper use of walking aids in order to reduce the risk of secondary peripheral nerve injuries.\u003c/p\u003e","manuscriptTitle":"Secondary Bilateral Compressive Radial Nerve Injury Induced by Crutch Use: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-31 01:12:16","doi":"10.21203/rs.3.rs-8395889/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"229199b8-c1b5-4ca0-974f-4d79ba06bd9e","owner":[],"postedDate":"December 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T04:23:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-31 01:12:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8395889","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8395889","identity":"rs-8395889","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}