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J R Soc Med. 2001 October; 94(10): 554.
PMCID: PMC1282232

Crutch walker's shoulder

Mr Davies and his colleagues conclude that, in a patient with Cushing's disease or avascular necrosis (AVN) at other sites, shoulder symptoms when crutch walking ‘should be enquired about and investigated radiographically’ (July 2001 JRSM, pp. 348-349). Crutch walking has wider relevance to AVN.

In 1983 I reported the cases of two perhaps osteoporotic but otherwise healthy women aged 73 and 59 who developed AVN of the humeral head as a result of crutch walking following isolated femoral neck fracture treated by internal fixation1. In both cases the condition was self-limiting and in one it was detected only as a result of full examination for medicolegal purposes seven months after the injury. I presented also a third patient who had used a walking aid in the right hand for over 10 years after unsuccessful hip replacement and who had developed glenohumeral osteoarthritis, the appearances of which were suggestive of previous aseptic necrosis.

I suggested that the condition probably was more common than appreciated because in those who use crutches for a limited period the symptoms were low-grade and spontaneous resolution takes place. With prolonged crutch walking, however, the condition might lead to glenohumeral osteoarthritis. Some support for this view was provided by a later paper reporting bilateral osteonecrosis of the humeral heads in a wheelchair-dependent T8 paraplegic2.

References

1. Pringle RG. Crutch walker's shoulder. In: Bateman JE, Welsh RP, eds. Surgery of the Shoulder. Decker and Mosby, 1984: 324-25
2. Barber DB, Gall NG. Osteonecrosis: an overuse injury of the shoulder in paraplegia: case report. Paraplegia 1991: 423-6 [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press