Author Topic: Case (63)  (Read 4615 times)

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Offline Dr.Habiib

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Case (63)
« on: January 24, 2011, 07:03:26 PM »
A  25- Year woman had severe fracture in her right tibia. A metal plate was surgically placed in her leg to stabize the fracture. She was told to use cratches for aproximately 3 months. After using the cratches about 6  weeks she noticed pain and parathesia in the posterior aspect of her right forearm and dorsum of hand .
The doctor told her that cause was prolong use of cratches.
1. Compressing of what nerve probably produce this pain?
2.WHY the doctor say that symptoms were result from prolong use of crutches?
3. Is this condition permanent or reversible?
4.How this nerve compression could be eliminated?
5. If the cause of nerve compression was not eliminated, what might be result?


Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient


Offline Diagnostic

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Re: Case (63)
« Reply #1 on: February 04, 2011, 03:29:04 PM »
1. Compressing of what nerve probably produce this pain?
Radial Nerve

2.WHY the doctor say that symptoms were result from prolong use of crutches?
The radial nerve is often injured in the axillary region from improperly fitted crutches. Prolonged pressure underneath the axilla from the crutches will compress the radial nerve especially for this lady who had severe tibial fracture. this is called (crutch palsy)

3. Is this condition permanent or reversible?
If the cause of radial neuropathy is found and treated, full recovery is possible. Most individuals treated conservatively with activity modification, splinting, and medication will experience a satisfactory long-term outcome.
Prognosis is excellent in 90% to 95% of individuals receiving decompressive surgery of the radial nerve (Harrop). However, the prognosis for improvement is not as good for individuals with normal electrodiagnostic studies who are treated surgically.

4.How this nerve compression could be eliminated?
Application of a neutral position wrist splint can help to rest the affected area and limit irritation to the radial nerve. Symptoms may be controlled by over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), or with a corticosteroid injection to reduce local inflammation and swelling around the nerve. Physical therapy may be prescribed to stretch tight soft tissues compressing the nerve and to strengthen surrounding muscles. Other nonpharmaceutical treatments, including transcutaneous electric nerve stimulation and acupuncture, may be considered as adjuvant to medication (Weiss and Weiss).

5. If the cause of nerve compression was not eliminated, what might be result?
Complications include permanent nerve damage that results in partial or complete loss of wrist and hand movement or sensation, muscular atrophy, and chronic pain.
In diagnosis think of the easy first.
Martin H. Fischer

Offline Dr.Habiib

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Re: Case (63)
« Reply #2 on: February 04, 2011, 05:53:04 PM »
Thanks  Daignostic   you are correct 100%
   thank you very much.
Ethical principles of medical professionalism:
1. Beneficence: to do good to patient.
2. Non maleficence: not to harm the patient.
3. Justice: to be fair to all patients.
4. Respect for autonomy: free decision for the patient


 

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