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Clonus s/p closed ankle fracture?
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Clonus s/p closed ankle fracture? - May 7, 2008 12:45:26 PM
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SiobhanPT
Posts: 6
Joined: April 24, 2008
Status: offline
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Help! New to this board. I am a pediatric P.T. w/primarily neuro experience but was asked to consult on adult s/p closed cancaneal fracture. Age 25, fell from ladder, no LOC. Cast removed recently. Moderate amount of edema, but nothing unusual for case. P.T. noted clonus on the involved side, 3-4 beat. No other neuro signs, babinksi WNL, no pronounced muscle wasting other than from 4 weeks in cast. Reflexes brisk on involved side, WNL on other. Any thoughts?? Thanks in advance. Siobhan
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RE: Clonus s/p closed ankle fracture? - May 23, 2008 12:05:04 PM
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mcap56
Posts: 616
Joined: October 26, 2002
From: New York, NY
Status: offline
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Hi:
This person fell from a ladder and now has neurlogical signs? I think it's an obvious case for a neurological workup. Let the doctors handle this one.
That said, over the years of clinical practice, I did have a few patients with clonus and no other obvious neuro signs. I spoke to our neurologist and she said it could be normal for people to have clonus (up to a certain number of beats) and still not have a neurological problem. That said, this is a fall. Get it checked out and have a conversation with the referring clinician or PCP.
Marc
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RE: Clonus s/p closed ankle fracture? - May 23, 2008 1:02:06 PM
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SJBird55
Posts: 2277
Joined: May 10, 2004
From: Michigan
Status: offline
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Before I recommended a neuro consult, I'd dig a bit deeper.
1) Medications
2) Look at both upper extremity and lower extremity deep tendon reflexes
3) Street drugs/alcohol use
4) Hoffman's
5) Some balance things - which will be difficult due to the actual injury, but I'd do them anyways: double stance eyes open compared to double stance eyes closed; tandem stance with involved in front compared to uninvolved in front; attempt single leg stance each lower extremity
6) check for nystagmus
7) check cranial nerves
8) might try timing ability to do alternating steps with maybe an 8-9" stool or an actual step - time to perform 8 repetitions - look at quality of performance too (again, due to injury, this may be difficult to perform)
9) assess gait
10) vital signs
I'd continue with PT services. I'd communicate the unusual findings with the PCP.
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RE: Clonus s/p closed ankle fracture? - May 23, 2008 2:32:14 PM
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TexasOrtho
Posts: 386
Joined: December 22, 2007
Status: offline
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I'd refer to neuro but keep treating. I would communicate the findings to the PCP over the phone. If you get the assistant just say "clonus" or "possible upper motor neuron sign" and the doctor should call you back. 
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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