|Home | About | Journals | Submit | Contact Us | Français|
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.