Simon:
Early for a Sudecks presentation. Although she is susceptible if she doesn't
start moving. Are you able to examine the elbow to any greater degree? Any
findings with palpation about the elbow? Any evidence of a brachial plexus
injury? Is she reluctant to move it or is she unable to move? What kind of
feedback are the parents giving her?
As for Rx I would try to get her moving any way you can. Will she do AAROM on the
wrist and hand with her other hand? I would also try light weight bearing on the
arm. You can also try the usual desensitization modalities as well. I like
whirlpool or fluidotherapy for these types of presentation because in addition to
the sensory stimulus they are likely to move the limb themselves in this
controlled environment.
Good luck.
[log in to unmask] wrote:
> 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
--
Douglas M. White, PT, OCS
Physical Therapist, Consultant
191 Blue Hills Parkway
Milton, MA USA 02186
P: 617.696.1974
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