Yilmaz F, Sahin F, Dalgic Yucel S, Oflazoglu B, Esit N, Kuran B
Sisli Etfal Teaching and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey.
Electromyogr Clin Neurophysiol. 2006 Nov-Dec;46(7-8):387-90.
In this report a case of bilateral shoulder fracture dislocations and C5 radiculopathy developed after an electrical injury is presented.
A 29 year-old male patient referred to our hospital with complaints of inability to raise his hands overhead starting 3 months ago after an electrical injury. The first physical examination revealed loss of strength (3/5) in deltoid muscles bilaterally, bilateral shoulder fracture dislocations and C5 radiculopathies. An open reduction and internal fixation (using K wire, cortical screw) procedure was applied for the right side in the Department of Orthopedics. Postoperatively active (A) and passive (P) ranges of motion (ROMs) were restricted extremely in the right and left shoulder respectively. Since applications of 15 sessions of electrical stimulation for deltoid muscle and physical treatment for both shoulders failed to achieve satisfactory ROMs, K wire extraction was instituted with resultant increase in the right shoulder A/P ROMs after 10 sessions of physical therapy postoperatively. At the last examination which was 18 months after the injury, ROMs of the right shoulder were increased, but not normal.
It must be remembered that in electrical injury, fractures and dislocations might occur in affected sites without any evidence of trauma with associated neurologic complications, and that these cases must be promptly detected and managed without any delay.
本报告介绍了一例电击伤后发生双侧肩部骨折脱位及C5神经根病的病例。
一名29岁男性患者因电击伤3个月前出现无法将手举过头顶的症状前来我院就诊。首次体格检查发现双侧三角肌肌力丧失(3/5)、双侧肩部骨折脱位及C5神经根病。骨科对右侧进行了切开复位内固定(使用克氏针、皮质骨螺钉)手术。术后,右肩和左肩的主动(A)和被动(P)活动范围(ROM)分别受到极大限制。由于对三角肌进行15次电刺激及对双肩进行物理治疗均未能使ROM达到满意效果,遂拔除克氏针,术后经10次物理治疗后右肩A/P ROM增加。在受伤后18个月的最后一次检查中,右肩ROM有所增加,但未恢复正常。
必须牢记,在电击伤中,受影响部位可能会出现骨折和脱位,而无任何创伤迹象,并伴有相关神经并发症,对于这些病例必须及时发现并立即处理。