Numbness or tingling in the arms or hands with crutch use suggests pressure in the armpit (crutch palsy) — stop and refit.
Before you read
Test yourself first: 4 questions
Question 1 of 4
Teaching crutch use on stairs, the nurse instructs the client that going UP stairs:
Answer: B. Going up: the STRONG (good) leg goes up first, then crutches and the weak leg. Going down: crutches and the weak leg first. 'Up with the good, down with the bad.'
Question 2 of 4
A client uses crutches and is taught the three-point gait. The nurse explains this gait is used when the client:
Answer: B. The three-point gait is used when one leg cannot bear full weight — both crutches and the affected leg advance together, then the strong leg. It is appropriate for a non-weight-bearing or partial-weight-bearing limb.
Question 3 of 4
The nurse is teaching a client to use crutches with a three-point gait after a right ankle fracture (non-weight-bearing on the right). Which instruction is correct?
Answer: B. In a three-point gait, both crutches and the affected (non-weight-bearing) leg advance together, then the client bears weight through the hands and swings the unaffected leg forward. Body weight is borne on the hands and palms, not the axillae, to avoid brachial plexus injury.
Question 4 of 4
A client is learning to use crutches with a non-weight-bearing right leg. Which instruction reflects correct crutch use?
Answer: B. Body weight should be borne on the hands and the hand grips, not the axillae, to avoid compressing the brachial nerves (crutch palsy). There should be about two finger-widths of space between the axilla and the crutch pad. Leaning on the underarm pads and placing the crutch tips directly under the arms are unsafe.
Keep the streak going with more questions like these, each with a full rationale.
What is canes, walkers & crutches?
Exam questions focus on fit, which side the device goes on, the gait sequence, and stairs. Correct technique prevents falls and nerve injury; poor technique can cause the very fall the device is meant to prevent.
Key points to remember
- Fit: with the device at the side, the handgrip sits at wrist level (the greater trochanter), so the elbow bends about 15–30 degrees.
- Cane: hold it on the strong (unaffected) side and move it forward together with the weak leg (COAL: Cane Opposite Affected Leg).
- Walker: move the walker a short step ahead, step into it with the weak leg first, then the strong leg; a standard walker is not used on stairs.
- Crutches: pads sit 2–3 finger-widths below the armpit, and weight is carried on the hands with the elbows slightly bent.
- Crutch gaits: 3-point when one leg cannot bear weight (both crutches and the injured leg move together, then the good leg); 4-point and 2-point when both legs can bear some weight; swing-to and swing-through for paralysis of both legs.
- Stairs: going up, the good leg leads, then the crutches or cane and the affected leg; going down, the crutches or cane and the affected leg lead.
Nursing priorities
- Check the fit and the rubber tips before the first walk; remove throw rugs and clutter.
- Assess strength, balance and orthostatic blood pressure before walking; use a gait belt for the first walks.
- Stand on the patient's weak side when assisting.
- Teach the gait that matches the ordered weight-bearing status.
- Have the patient show the gait and the stairs technique (return demonstration) before discharge.
Patient teaching
- Cane in the hand opposite the weak leg; move the cane and the weak leg together.
- Up with the good, down with the bad.
- Wear flat, nonskid shoes, keep paths clear and well lit, and replace worn rubber tips.
Red flags: report now
- Numbness or tingling in the arms or hands with crutch use suggests pressure in the armpit (crutch palsy) — stop and refit.
- Dizziness, a fall, or new pain in the affected leg needs reassessment before the patient walks again.
- Never let body weight rest on the crutch pads in the armpit.
References
Clinical references for this topic
