Pressure by the upper end of a crutch may cause injury to the?

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

The upper end of a crutch, when used incorrectly, exerts direct pressure on the axilla (armpit).
The axillary nerve passes through the axilla and is relatively superficial, making it highly susceptible to compression.
This compression injury is known as "crutch palsy" or crutch paralysis.
The primary symptoms of axillary nerve injury are weakness in the deltoid muscle (difficulty lifting the arm sideways) and numbness over the side of the shoulder.

Option B: The long thoracic nerve runs down the side of the chest wall to supply the serratus anterior muscle. It is not located within the axilla in a way that it would be compressed by the top of a crutch.
Option C: The median nerve travels down the middle of the arm and is not in the direct line of pressure from the axillary pad of a crutch.
Option D: The ulnar nerve runs along the medial (inner) side of the arm and is most vulnerable where it passes behind the medial epicondyle of the elbow (the "funny bone"). It is not compressed by the crutch pad in the axilla.

Clinical Relevance

Nursing practice connection: Knowing Peripheral nerve injury due to improper use of assistive devices helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A primary nursing responsibility is patient education on the proper use of assistive devices to prevent iatrogenic (medically-induced) injuries like crutch palsy.
Nurses must perform and document neurovascular assessments for patients using crutches, checking for sensation, motor function, and any patient complaints of numbness or tingling.
What if? If a patient using crutches complains of numbness and weakness in their hand, particularly the thumb, index, and middle fingers, the nurse should suspect compression of the median or radial nerve at the handgrip or wrist, rather than the axillary nerve.

How to Approach the Question

First, identify the key anatomical location implicated by the question stem: the "upper end of a crutch" corresponds to the axilla or armpit.
Next, mentally review or visualize the major nerves that pass through the upper arm and shoulder region.
Evaluate each option based on its anatomical course. The axillary nerve is named for its location and passes directly through the axilla.
The long thoracic, median, and ulnar nerves have different pathways that are not directly compressed by the top of a crutch in the axilla.
Conclude that the axillary nerve is the structure most at risk, a condition clinically known as crutch palsy.

Concept Tested & Keywords

Concept Tested: Peripheral nerve injury due to improper use of assistive devices.
Stem keywords: crutch, pressure, injury, upper end
Lead-in keywords: cause injury to
Negative lead-in flag: false

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E6 Anatomy MindMaps BDChaurasia V1 10e p. 5-7

Practise the full AIIMS Bhatinda NO - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.