lesions of the anterior interosseous nerve are rare and comprise less than 1% of all upper extremity nerve palsies .
traumatic causes include blunt trauma , forearm fractures , penetrating injury and local pressure from a plaster cast , but has never before been described in association with crutch use .
this is the first reported case of the use of elbow crutches causing symptomatic anterior interosseous nerve compression .
this case describes a 30-year - old male who developed an inability to pinch with his left hand following the use of elbow crutches for a foot injury . on examination
a diagnosis of anterior interosseous palsy was made and the patient was treated conservatively and crutch use was ceased . at six weeks
follow - up the patient made a complete recovery with full function of his left hand .
this report highlights the importance of adequate education in the safe use of elbow crutches for all patients .
the side effects of inappropriate use should be carefully examined for during follow - up care .
lesions of the anterior interosseous nerve [ ain ] are rare and comprise less than 1% of upper limb palsies .
it is an exclusively motor branch of the median nerve and provides innervation to flexor pollicis longus , the medial part of flexor digitorum profundus involving the index and sometimes the middle finger , and to pronator quadratus .
entrapment of the nerve results in a characteristic appearance on pinching , which may be mistaken for a tendon rupture .
we present a case of a patient who developed ain palsy following the use of elbow crutches .
a 30-year - old fit and healthy male presented to fracture clinic four days after suffering a stubbing injury to his left big toe and superficial abrasion to his left heel .
x - rays reviewed an undisplaced fracture of the base of the left little toe distal phalanx . he was given elbow crutches with instructions for partial weight bearing on the affected leg and discharged with a fracture clinic appointment . in clinic ,
the patient complained of a gradual onset of difficulty in pinching and gripping objects with his left hand since the injury .
[ figures 1 and 2 ] movements of the left index and middle fingers were normal and there were no areas of paraesthesia . since there was no history of trauma or predisposing conditions , we believe the patient developed an anterior interosseous nerve palsy following the inappropriate use of elbow crutches over four days .
he was subsequently placed in a plaster cast boot and was advised to fully weight bear without the use of crutches .
however , by the time he came to a six - week follow - up clinic after the injury , he had made a complete clinical recovery in hand movement and function .
many causes for ain palsy have subsequently been described in literature , and can be divided into traumatic and non - traumatic / spontaneous .
traumatic causes range from blunt trauma , local pressure from sleeping on the affected arm or poorly applied cast , excessive exercise , penetrating injury , forearm fractures and open reduction and internal fixation . to our knowledge
ain palsy can be described as complete , where flexor digitorum profundus and flexor pollicis longus are both affected , or incomplete , where only one muscle is affected .
it differs from other lesions of the median nerve in that sensory complaints are essentially absent . as a result of these factors
, ain palsy can often mimic single tendon lesions , leading to difficulties with diagnosis . in the literature , there are cases of ain entrapment with unnecessary surgical exploration of fpl tendon .
o with the thumb and index finger , and the loss of ability to perform fine tasks despite an intact sensory innervation .
spontaneous ruptures of flexor pollicis longus tendon are rare and are generally associated with distinct underlying pathologies , such as rheumatoid arthritis .
several clinical tests have been described to distinguish between palsy of fpl and rupture of this tendon[810 ] .
electrodiagnosis with nerve - conduction study or electromyography is the investigation of choice to differentiate between nerve palsy and tendon rupture . in the present case , however , the patient made a full recovery before electrodiagnostic studies could be carried out , thereby ruling out the possibility of rupture of flexor pollicis longus .
conservative management includes removal of precipitating causes such as crutches and casts , immobilisation and anti - inflammatory medication .
we believe all patient should be taught safe and effective usage of elbow crutches when they initially receive them .
the side effects of inappropriate use should be carefully examined for during follow - up care .
 context : lesions of the anterior interosseous nerve are rare and comprise less than 1% of all upper extremity nerve palsies . 
 traumatic causes include blunt trauma , forearm fractures , penetrating injury and local pressure from a plaster cast , but has never before been described in association with crutch use . 
 this is the first reported case of the use of elbow crutches causing symptomatic anterior interosseous nerve compression.case report : this case describes a 30-year - old male who developed an inability to pinch with his left hand following the use of elbow crutches for a foot injury . on examination 
 he was unable to flex the interphalangeal joint of his left thumb . 
 a diagnosis of anterior interosseous palsy was made and the patient was treated conservatively and crutch use was ceased . at six weeks 
 follow - up the patient made a complete recovery with full function of his left hand.conclusion:this report highlights the importance of adequate education in the safe use of elbow crutches for all patients . 
 the side effects of inappropriate use should be carefully examined for during follow - up care . 
Context:
Case Report:
Conclusion:
Introduction
Case Report
Discussion
Conclusion