Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada.
PM R. 2023 May;15(5):570-578. doi: 10.1002/pmrj.12809. Epub 2022 Jun 11.
Axillary crutches are commonly used in rehabilitation. Inappropriately fit crutches may result in upper limb pain or injury.
To investigate the effects of axillary crutch length on upper limb kinematics to better understand potential injury mechanisms. It was hypothesized that crutches that were longer or shorter than standard-fit crutches would alter upper limb kinematics.
Cross-sectional.
Gait laboratory.
Fifteen healthy males with no prior crutch experience.
Participants were fit with axillary crutches using standardized methods, as well as with crutches that were 5 cm longer and 5 cm shorter. Participants performed swing-through gait (1.20 ± 0.07 ms ) with all crutch lengths in randomized order. Kinematics were recorded using an optical motion-tracking system and joint angles for the scapula, shoulder, elbow, and wrist were computed.
The effects of crutch length on joint range of motion (ROM) and joint angles at initial crutch contact were analyzed using multivariate analysis (Hotelling's T ; α = .025) and simultaneous confidence intervals (CI).
The long-standard crutch fit comparison showed effects across all joints (ROM p = .009; initial contact p < .001). Longer crutches resulted in greater scapular upward rotation (mean difference [95% CI] ROM: 1.0 [-0.2 to 2.2]; initial contact: -2.7 [-4.4, -1.1]) and shoulder abduction (ROM: 0.8 [-0.1 to 1.8]; initial contact: -1.9 [-4.1 to 0.3]). Crutch length also had effects across all joints for the short-standard fit comparison (ROM p = .004; initial contact p = .016). Shorter crutches resulted in greater scapula downward rotation (2.2 [-0.4 to 4.8]) and greater shoulder adduction (2.5 [-0.6 to 5.6]) at initial contact. Shorter crutches also reduced shoulder flexion/extension ROM (-2.5 [-4.4 to -0.6]).
Altered crutch length results in scapular and shoulder kinematic deviations that may present risk factors for upper limb injury with crutch-walking. This may underline the importance of appropriate device fitting to reduce injury risk in crutch users.
腋拐在康复中被广泛使用。不合适的腋拐可能会导致上肢疼痛或受伤。
研究腋拐长度对上肢运动学的影响，以更好地了解潜在的损伤机制。假设长于或短于标准适配腋拐的腋拐会改变上肢运动学。
横断面研究。
步态实验室。
15 名无腋拐使用经验的健康男性。
参与者使用标准化方法适配腋拐，并适配长 5cm 和短 5cm 的腋拐。参与者以随机顺序用所有腋拐长度进行摆动通过步态（1.20±0.07ms）。使用光学运动跟踪系统记录运动学，计算肩胛骨、肩部、肘部和腕部的关节角度。
使用多元分析（Hotelling's T；α=0.025）和同时置信区间（CI）分析腋拐长度对关节活动范围（ROM）和初始腋拐接触时关节角度的影响。
长标准腋拐适配比较显示所有关节均有影响（ROM p=0.009；初始接触 p<0.001）。更长的腋拐导致更大的肩胛骨上旋（平均差异[95%CI]ROM：1.0[-0.2 至 2.2]；初始接触：-2.7[-4.4，-1.1]）和更大的肩部外展（ROM：0.8[-0.1 至 1.8]；初始接触：-1.9[-4.1 至 0.3]）。短标准腋拐适配比较也对所有关节有影响（ROM p=0.004；初始接触 p=0.016）。更短的腋拐导致更大的肩胛骨下旋（2.2[-0.4 至 4.8]）和更大的肩部内收（2.5[-0.6 至 5.6]）在初始接触时。更短的腋拐还减少了肩部屈伸 ROM（-2.5[-4.4 至 -0.6]）。
腋拐长度的改变导致肩胛骨和肩部运动学的偏差，这可能是使用腋拐行走时上肢受伤的危险因素。这可能强调了适当设备适配以降低腋拐使用者受伤风险的重要性。
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