POST TRAUMATIC SWELLING
68yrs female had H/0 of fall on right hand 1 week back .C/0 pain in right shoulder with contusion over right pectoral area.was treated by a quack by some unknown injection.post injection presented to me with above discoloration and swelling of the arm.shoulder movements are intact.how should I further proceed with the case.
History of fall on rt hand Discoloration suggest hematoma on dorsum of rt hand We need xray rt hand to r/o bony injury which is most likely FRACTURE metacarpels but without xray difficult to comment Nothing to do with injection taken Contusion on chest need xray chest to r/o FRACTURE ribs Also adv xray rt shoulder
Swelling is because of injury Haematoma is likely there Get X-ray done of whole limb weather any bony injury is or not treat accordingly Limb elevated Antibiotics orally antibiotics locally Nsaid orally Tab Medrol 8 mg bd
Post traumatic sweling of hand and wrist treated by quack most probably due massage and hot appication and without movements of fingers and discouration may be bleeding in subcutaneous space. As you have mentioned no fracture detected on x-rays then treat conservatively with A. Antibiotic B. Anti inflammatory C analgesic D. Finger movement is the must E. No massage or hot compress which may cause more swelling.
Swelling is due to soft tissue injury xray to r/0 colles Tight bandage Elevation of hand Enzoflam 1 tds
Looks like compartment syndrome. Remove the metal armaments first. check distal neuro vascular status. Check RT upper Limb oxyzen saturation. get x-rays of wrist AP and Lateral views. If saturation not adequate go for arterial color Doppler. Orthopedic surgical intervention needed May need fasciotomy. pop slab.analgesics,limb elevation,arm sling pouch,active finger movements.
SUGGESTIVE. OF . POST. TRAUMATIC EDEMA / CELLULITIS
Adv. X ray of hand Rx NSAID ANTIBIOTIC D.F.O. GEL
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