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CONDITION/DISORDER SYNONYMS
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PREFERRED PRACTICE PATTERN3
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4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation
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PATIENT PRESENTATION
A 38-year-old man with a recent supracondylar humerus fracture presents with disproportionate unilateral forearm pain. He is currently experiencing tingling in the area. His radial pulse is absent. Distal phalanges are blanched tint and are cool to the touch. His wrist and fingers are in a flexed position and he has diminished sensation on the volar side of his hand.
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Flexion contracture of the wrist, resulting in claw-like deformity
Obstruction of brachial artery near the elbow
Three levels of severity
Mild: Contracture of two or three fingers only, only limited sensation deficit
Moderate: All fingers (including thumb) contracted in flexed position; wrist may be in flexion and slight sensation loss
Severe: All muscles in the forearm affected (flexors and extensors)
Arteriolar compression occurs and causes muscle and nerve ischemia
Acute, sensory changes develop after 30 minutes of ischemia
Acute, irreversible nerve damage in 12 to 24 hours
Acute, irreversible muscle changes (i.e., necrosis) in 3 to8 hours
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Essentials of Diagnosis
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Diagnosis is typically made by clinical examination and compartment pressure measurement
Severe pain that is not alleviated by elevation or pain medication
Distal pulses are diminished/absent
Strength and sensation are diminished
Edema in affected limb
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General Considerations
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Younger age, high-energy/high-velocity trauma, and systemic hypotension associated with an increased risk of traumatic accident
More common in children
High-risk patients include:
Individuals using circumferential wraps, restrictive dressings, casts, or immobilizer are at an increased risk
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