Dear All,
Any help with the following would be gratefully received.
A 9 year old girl presenting with a 3 week old fracture of her left clavicle.
It was x-rayed at the time and 2 days prior to examination at which stage it
was showing good signs of healing. Only moderate tenderness over the fracture
site and callous formation easily palpable.
She had also suffered some Elbow trauma, with gross swelling at the time of
injury ( a fall off a small wall) - X-rayed twice with NBI.
My concern was with the state of her forearm and hand. She presented with a
gross reluctance to move her elbow, hand or fingers - constantly supporting
her arm and hand in a position across her chest. Although she had no loss of
fine touch sensation she had origionally described a hyperaesthesia which was
now not present. Her active movements could only elicit a flicker of
movement of finger flexion, extension and wrist flexion and extension plus
all thumb movements. Her fingers were held in a flaccid flexion posture with
passive extension causing considerable discomfort. Her palm was warm and
sweaty. Passive movement of pronation and supination of the forearm were
pain free and full, although extension of her elbow was painful and not
tested to full range.
Could she be in an early stage of Sudeck's atrophy?, some form of Reflex
sympathetic dystrophy?, a neuropraxia?
I am worried that I may be missing something.
Any suggestions most welcome,
Yours
Simon Love
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