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Crutches

Aka: Crutches, Axillary Crutches, Forearm Crutches, Canadian Crutches, Lofstrand Crutches, Platform Crutches
  1. See Also
    1. Mobility Device
    2. Assistive Technology
    3. Canes
    4. Walkers
    5. Wheelchair
  2. Indication
    1. Gait disturbance (full weight bearing)
  3. Advantages
    1. Significant weight bearing support (80% for one crutch and 100% for two Crutches)
    2. Most Crutches are adjustable for patient height (fit is critical to proper use - see below)
    3. Crutches have two points of body contact (axilla and hand)
      1. Contrast with canes that have only one point of body contact
  4. Disadvantages
    1. High energy expenditure and upper body strength requirement
    2. Unsuitable option for frail elderly
  5. Types
    1. Axillary Crutches
      1. For temporary use (acute injuries)
      2. Adjustable aluminum or wooden Crutches
      3. Requires significant upper body strength
      4. May be difficult to use and cumbersome
      5. Padded crutch top that fits within the axilla
        1. However the padded top is NOT intended to support body weight
        2. Maintain a gap of 1.5-2.0 inches between crutch top and axilla
        3. Risk of nerve or artery compression in axilla if incorrectly used and full body weight is applied to crutch top
    2. Forearm Crutches (Canadian crutch, Lofstrand crutch)
      1. For longterm use in active patients with severe leg weakness
      2. Requires good upper body strength and truncal balance
      3. Lightweight, adjustable Crutches
      4. Offers easier mobility than with Axillary Crutches
      5. Forearm cuff attaches 2 inches below elbow
      6. Hands grasp handpiece with elbows flexed to 2-30 degrees
      7. Brace fixes crutch to Forearm and hands grasp handles
        1. Allows use of hands without dropping Crutches
        2. Less cumbersome on stairs than axillary crutch
    3. Platform Crutches
      1. Axillary crutch that adds a horizontal padded platform to support the Forearm
      2. Better stability than with Axillary Crutches
      3. Consider in patients with weak hand grip
      4. Decreased maneuverability and least used of Crutches
  6. Technique
    1. Two point
      1. Advance left crutch and right leg together, then
      2. Advance right crutch and left leg together
    2. Four point (most stable)
      1. Crutches and legs move independently
      2. Advance left crutch
      3. Advance right leg
      4. Advance right crutch
      5. Advance left leg
  7. Fitting
    1. Axillary Crutches
      1. Elbows bent to 30 degrees flexion while holding crutch handles
      2. Crutch base sits 6 inches anterior and 2 inches lateral to foot
      3. Allow adequate space between top of crutch and axilla
        1. Crutch top should have a space of 4-5 cm (~2 inches) below axilla
        2. Axilla should not rest on top of crutch
    2. Forearm Crutches (Canadian crutch, Lofstrand crutch)
      1. Plant crutch end in front of foot by 6 inches
      2. Keep elbow slightly flexed to 15 to 30 degrees
      3. Place cuff at proximal Forearm just distal to elbow (2.5 to 4 cm below the olecranon)
  8. References
    1. Bradley (2011) Am Fam Physician 84(4): 405-11 [PubMed]
    2. Sehgal (2021) Am Fam Physician 103(12): 737-44 [PubMed]
    3. Van Hook (2003) Am Fam Physician 67(8):1717-24 [PubMed]

Crutches (C0010397)

Definition (UMD) Assistive devices consisting of a shaft that bifurcates at some point from the distal tip. They are designed to provide additional support to the user while walking. These devices usually consist of a shaft that bifurcates partway up from the distal tip (i.e., base); a handle at the proximal end finished in a soft pad; and a rubber tip at the distal end(s). Some crutches have several (e.g., three to four) distal tips to improve floor contact. Crutches are typically made of sturdy materials such as wood (e.g., walnut), light metals (e.g., aluminum, titanium), fiberglass, or a combination of these. Most common types of crutches include axillary (i.e., underarm) and forearm designs. Other dedicated (e.g.; platform and tripod) crutches are also available. Crutches are adjustable for the user's height and arm length and are commonly used in pairs.
Definition (NCI) A wooden or metal staff that fits under the armpit and reaches to the ground, used as an aid while walking.
Definition (SPN) A crutch is a device intended for medical purposes for use by disabled persons to provide minimal to moderate weight support while walking.
Definition (MSH) Wooden or metal staffs designed to aid a person in walking. (UMDNS,1999)
Concepts Medical Device (T074)
MSH D003446
SnomedCT 74566002, 363753007
English Crutches, CRUTCH, CRUTCH MISC. EACH, CRUTCH @ @ EACH, CRUTCH EACH, Crutch, device, crutches (treatment), crutches, CRUTCH MISCELL EACH, CRUTCH@@MISCELL@EACH, crutch, Crutch, Crutch, device (physical object), Crutches (physical object)
Swedish Kryckor
Czech berle
Finnish Tukisauvat
Russian KOSTYLI, КОСТЫЛИ
French Béquilles
Polish Kule ortopedyczne, Kule inwalidzkie
Norwegian Krykker
Spanish muleta (objeto físico), muletas (objeto físico), muletas, muleta, Muletas
German Gehstützen, Krücken
Italian Grucce
Dutch Kruk, Krukken
Portuguese Muletas
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Crutches, Axillary (C0180197)

Definition (UMD) Crutches supported under the arms that are designed to provide the user with additional support while walking. These crutches consist of a shaft that bifurcates partway up from the distal tip and is connected at the top and middle by a crossbar; it also has a rubber tip at the distal end. The top cross bar is slightly concave in shape to fit below the axilla (i.e., underarm) and is covered with a soft rubber pad used to brace the crutches against the body, the middle crossbar is round and covered with a rubber grip that adjusts to hand level for gripping the crutches with the hands. The distal end is covered by a rubber tip that contacts the floor. They are typically made of sturdy materials such as wood (e.g., walnut), light metals (e.g., aluminum, titanium). Axillary crutches are commonly used in pairs to assist in weight bearing and balance; some (i.e., metal) have spring-loaded detents that facilitate adjustment of hand grip height and overall length.
Concepts Medical Device (T074)
English Crutches, Axillary, axillary crutch, axillary crutch (treatment), Axillary Crutches
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Crutches, Forearm (C0180199)

Definition (UMD) Crutches supported by the forearms that are designed to provide the user with additional support while walking. These crutches consists of two pieces of light metal tubing that are telescoped one within the other to adjust to the correct height of the user, swivel-action arm cuffs that fit partially around the forearm; handgrips covered with a rubber grip; and a rubber tip at the distal end that meets the floor. Forearm crutches are designed to allow the user to slip his arm into the cuff and thus hold the grip tightly. The cuff can be semi-circular or circular in shape, with a V-shaped opening on the front from where the arm can be slid into the crutch. They are typically made of sturdy materials such as light metals (e.g., aluminum, titanium), plastic (e.g., rubber), or a combination of these. Collapsible (i.e., folded/adjustable) forearm crutches are also available. Forearm crutches are intended to be used by individuals suffering from some sort of permanent physical disabilities.
Concepts Medical Device (T074)
English Crutches, Forearm, crutches forearm, forearm crutches, Forearm Crutches, Forearm Crutch
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Crutches, Forearm Platform (C3689204)

Definition (UMD) Crutches supported by forearm platforms that are designed to provide additional support to users with gripping limitations. These crutches usually consist of a shaft that bifurcates partway up from the distal tip and a platform for transmission of the load to the shoulder girdle. They also include padded troughs upon which the forearms rest; vertical handgrips to hold on to; straps to be applied around the forearm to keep it in place; and a rubber tip(s) at the distal end that meets the floor. They are typically made of sturdy materials such as light metals (e.g., aluminum, titanium), plastic (e.g., rubber), or a combination of these. Platform forearm crutches are intended to be used by individuals with gripping limitations or problems bearing weight in the hand, wrist, or forearm thus providing a larger area of contact and more stability than the standard forearm crutch.
Concepts Medical Device (T074)
English Forearm Platform Crutches, Crutches, Forearm Platform
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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