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12 year old with "dead arm"

 
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12 year old with "dead arm" - October 26, 2005 12:00:00 PM   
bburas

 

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hey forum,

i was just refered a 12 yr old boy with onset of right arm paralysis. they suspect a virus that attacked his anterior horn (pt reports sustaining multiple mosquito bites prior to problem). He has trace mm activity of his thumb and 3rd digit and some scapular control but that's it.

i issued his family HEP for ROM and some scapular exercises as well as assisted weight bearing through his UE.

any treatment ideas out there? any insite into recovery time, expectations? thanks in advance.

brett
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Re: 12 year old with "dead arm" - October 26, 2005 12:14:00 PM   
avalon

 

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Please Brett,

When did the problem occurred?

_____________________________

http://www.somasimple.com

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Re: 12 year old with "dead arm" - October 26, 2005 12:35:00 PM   
bburas

 

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From: colorado springs, co, usa
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Henry,

The problem occurred about 1 month ago. He's had very slow return of function. He does have full sensation throughout the upper extremity.

Brett

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Re: 12 year old with "dead arm" - October 26, 2005 5:36:00 PM   
jma

 

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Has a pediatric neurologist been consulted in this particular case? If not, what tests have been conducted to determine the severity of the paralysis?

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Re: 12 year old with "dead arm" - October 26, 2005 5:55:00 PM   
SJBird55

 

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You mentioned mosquitos... by any chance to the physicians believe West Nile Virus is a culprit?

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Re: 12 year old with "dead arm" - October 26, 2005 5:56:00 PM   
SJBird55

 

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There was a recent article in JOSPT... can't remember the details, but what happened to be DX as radiculopathy turned out to be something else.... can't remember what.

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Re: 12 year old with "dead arm" - October 26, 2005 6:42:00 PM   
bburas

 

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The pt's mom said they suspected west nile virus ans that it attacked the anterior horn cells. and that's kind of my question. i have no idea what to expect or what kind of goals to set or a time frame to work off of.

he's had an mri, he didn't have an emg. nothing is conclusive.

i treat primarily (exclusively actually) and dont have much experience with sci/neurological cases. am i simply maintaining motion and waiting for mm return?

brett

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Re: 12 year old with "dead arm" - October 26, 2005 6:45:00 PM   
jma

 

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Here is the abstract of the article you mentioned below. Very interesting.

"October 2005 Vol.35 No.10

Cervical Radiculopathy or Parsonage-Turner Syndrome: Differential Diagnosis of a Patient With Neck and Upper Extremity Symptoms

Christopher J. Mamula, MPT, ATC, Staff Physical Therapist/Athletic Trainer, Western PA Sports Medicine and Rehabilitation, Somerset, PA
Richard E. Erhard, PT, DC, Assistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
Sara R. Piva, PT, MS, OCS, FAAOMPT, Instructor and Doctoral Candidate, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA

Study Design: Resident?s case problem.

Background: The signs and symptoms of cervical radiculopathy (CR) warrant the consideration of several other conditions in CR?s differential diagnosis. One condition that may mimic CR, which is not well known among physical therapists, is Parsonage-Turner syndrome (PTS). PTS is characterized by an onset of intense pain that typically subsides within days to weeks. However, as pain subsides, weakness and/or paralysis may develop in upper extremity muscles. The purpose of this resident?s case problem is to describe a patient who presented to our clinic with a diagnosis of CR, but had findings consistent with PTS.

Diagnosis: The patient was a 43-year-old male referred to physical therapy with a diagnosis of CR. He had a previous episode of CR 1 year ago that was treated successfully. He had positive magnetic resonance imaging findings of structural abnormalities suggestive of causative factors for CR. The patient was treated for CR with thoracic and cervical spine manipulations and intermittent cervical traction. The initial acute severe pain subsided, but weakness in the upper extremity worsened. Diagnosis of PTS was made upon exclusion of other potential confounding diagnoses and the findings of fibrillation potentials and positive waves in electrodiagnostic studies.

Discussion: CR and PTS are characterized by pain in the cervical spine, shoulder, and upper extremity. CR generally has an insidious onset, while PTS has a rapid onset of intense pain. Symptoms of CR are exacerbated with neck movements, while symptoms related to PTS should not be exacerbated with neck movements. In patients that do not respond to conventional therapy and have a progression of upper extremity muscle weakness, regardless of decreased pain, the diagnosis of PTS should be considered. J Orthop Sports Phys Ther. 2005;35(10):659-664."

Although the weakness seems similar, there is no mention of pain in the 12 year old. According to the article, the incidence of Parsonage-Turner Syndrome (PTS)is from 30-70 years of age.

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Re: 12 year old with "dead arm" - October 27, 2005 8:18:00 AM   
SJBird55

 

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Thanks, jma - that would be the article. Yep, Brett... see if the kid had pain prior to the paralysis.

He did or he didn't have an EMG? With paralysis, I'd think that an EMG would be necessary.

head to http://www.cdc.gov/ncidod/dvbid/westnile/clinicians/

educate yourself on the West Nile Virus. Potentially unlikely seeing that more commonly there are complaints of fever and headache if there are any symptoms. More like meningitis or encephalitis symptoms if any... and the paralysis can occur, but isn't as common.

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Re: 12 year old with "dead arm" - October 27, 2005 10:03:00 AM   
eam

 

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Hi Brett-
I am treating a woman with similiar symptoms. She is much older in her 60's. Could not lift her arm at all. Her onset was just after her husband died although they believe it started sooner-she just did not notice it b/c she was so busy taking care of her husband. She had an emg which showed evidence of deinnervation (spelling?)-no nerve conduction problems. She had an MRI, CT scan head and shoulder and all the blood work (west nile, lymes etc) and they were all negative. They initially gave her a diagnosis of ALS, believe it or not, then they changed it to Monomyleic Myotrophy (not sure of the exact spelling ).
We have treated her with a variety of strengthening, motor control exercises etc and she has improved. She just had a recent EMG and it showed significant improvement in motor recuitment as well as decreased to zero mm fasiculations at rest.
The MD's believe that since she has improved, she most likely had a virus of some sort. Interesting case since no one really has a clue as why this started.
Good luck!
Erica

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Re: 12 year old with "dead arm" - October 27, 2005 11:22:00 AM   
SJBird55

 

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Doesn't it seem that there have been more and more viruses causing UE symptoms?

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Re: 12 year old with "dead arm" - October 27, 2005 12:44:00 PM   
bburas

 

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Thanks for the info everyone. SJ, that website should be very helpful. I just hope this poor kid regains use of his arm.

Brett

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Re: 12 year old with "dead arm" - October 28, 2005 8:46:00 AM   
eam

 

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SJ-
I also have another patient who after his first spinal epidural developed a "chicken pox" type of rash ALL over his back and chest. Unbelievable, I have never seen anything like it before. They think it is some sort of virus.
Erica

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Re: 12 year old with "dead arm" - October 28, 2005 2:07:00 PM   
srcase

 

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Maybe I'm cynical, but don't doctors commonly say it's a virus when they don't really know what's going on? It seems they rule out everything else, and just say, "it's probably a virus". That happened to my sister-in-law and they still don't know what's wrong with her, and it's been a year with diffuse neurological symptoms.

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