Secondary Bilateral Compressive Radial Nerve Injury Induced by Crutch Use: A Case Report

Background Secondary radial nerve injury caused by crutch use is relatively uncommon in clinical practice, and simultaneous bilateral involvement is even rarer. Such injuries are easily overlooked in the early stage, particularly among patients who require long-term assisted ambulation following lower-limb surgery. Reporting such cases helps raise clinical awareness of peripheral nerve injuries associated with assistive devices and contributes to the optimization of diagnostic and preventive strategies. Case presentation: The patient was a 54-year-old man who developed progressive bilateral weakness of wrist and finger extension after prolonged crutch-assisted ambulation following lower-limb fracture surgery. Physical examination revealed bilateral “wrist drop” and “finger drop” deformities, with extensor muscle strength of the wrist and metacarpophalangeal joints graded as M1, while muscle strength of the shoulder and elbow joints was normal. Cervical MRI showed no evidence of nerve root or spinal cord compression, and electromyography confirmed bilateral radial nerve injury. Comprehensive conservative management was initiated, including discontinuation of crutch use, functional-position wrist immobilization, and adjunctive therapy with glucocorticoids, neurotrophic agents, physical therapy, and hyperbaric oxygen therapy. After 2 weeks of treatment, extensor muscle strength of the left wrist and metacarpophalangeal joints improved to M3, while the right side recovered to M2. At the 2-month follow-up, further improvement was observed, with recovery to M4 on the left side and M3 on the right side. Conclusions Prolonged improper use of crutches may result in compressive radial nerve injury, and the early clinical manifestations are often easily overlooked. Careful acquisition of a detailed medical history combined with electrophysiological evaluation is essential for establishing an accurate diagnosis and improving patient outcomes. In addition, greater emphasis should be placed on educating patients about the proper use of walking aids in order to reduce the risk of secondary peripheral nerve injuries.