Article Text
Summary
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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Footnotes
Peter Macneal and Christopher Robert Crome are joint first authors.
Contributors CRC (joint first author) identified the case report and involved in planning the draft, as well as formulating the key points of the history to write the case report. PM (joint first author) reviewed the paper in the context of recent literature to write the background and discussion sections of the paper. SMcN involved in the planning of the case report and critically reviewed the draft prior to submission.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.