Patient age 65 years old male came to opd with history of flexion at left elbow joint and wrist joint and fingers and flexion at left knee joint for 8 years.No history of trauma is there unable to extend his left hand ..Posture shown in pic.Managment ???? and diagnosis



dd 1) sequale of hemipleia of left side 2) just brachial plexopathy of left upper limb with knee stiffness 3) as age is 65 may be age related arthritis of bilateral knee and bracheal plexopathy 4) history is not sufficient in termes of history of trauma any diseases ? so on

I agree

Missed case and untreated case of hemiplegia of left side Developed synergistic pattern of limbs and may have developed contracture or deformity ?? Neurologist consultation required along with orthopedic consultation Please check the ROM of flexed joints, whether they are fully restricted or have full apssive ROM

Thank you sir @Pankaj Singhal

Rule out rheumatoid arthritis and other serious negative arthopathies. 8 years is a long time.Most likely all the joints my have been ankylosed. Complete blood profile Esr ,CRP,RA FACTOR,Hla b27 test,Anti cca test X ray of the involved joints. Start him on DMARD As of now

Thank you doctor

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flexion synergy hemiplegia... is there any brain mri???

No mri sir

It's look like hemiplegia He need proper physiotherapy Stretching of muscles And braces Knee brace and arm emoblizer

Any history of stroke