Tetanus physical examination: Difference between revisions
No edit summary |
m (Bot: Removing from Primary care) |
||
(28 intermediate revisions by 7 users not shown) | |||
Line 1: | Line 1: | ||
__NOTOC__ | |||
{{Tetanus}} | {{Tetanus}} | ||
{{CMG}} | {{CMG}} | ||
{{MJM}} | {{MJM}}; {{AE}} {{USAMA}} | ||
==Overview== | ==Overview== | ||
The | Tetanus initially presents with [[muscle]] stiffness. The distribution may vary with the type of tetanus. [[Masseter muscle|The masseter muscles]] are commonly involved with an accompanying [[headache]]. [[Neck]] stiffness, difficulty [[swallowing]], generalized muscle [[spasms]] including the abdominal and back muscles and [[sweating]] may be seen later in the disease. In severe cases, respiratory paralysis may develop, which presents with [[apnea]], [[Hypoxemia|hypoxia]] and [[hypercapnia]]. | ||
==Physical Examination== | ==Physical Examination== | ||
Tetanus initially presents with [[muscle]] stiffness. The distribution may vary with the type of tetanus. [[Masseter muscle|The masseter muscles]] are commonly involved with an accompanying [[headache]]. [[Neck]] stiffness, difficulty [[swallowing]], generalized muscle [[spasms]] including the abdominal and back muscles and [[sweating]] may be seen later in the disease. In severe cases, respiratory paralysis may develop, which presents with [[apnea]], [[Hypoxemia|hypoxia]] and [[hypercapnia]]. | |||
* | Tetanus must be suspected in patients with: | ||
*An injury involving contact of broken skin with contaminated environment, soil or dust. | |||
*An absent or inconsistent history of [[Immunization|immunizations]]. | |||
Physical examination of a patient with tetanus may reveal the following:<ref>{{Cite journal | |||
| author = [[Mohamed Amirali Gulamhussein]], [[Yueyang Li]] & [[Abhijit Guha]] | |||
| title = Localized Tetanus in an Adult Patient: Case Report | |||
| journal = [[Journal of orthopaedic case reports]] | |||
| volume = 6 | |||
| issue = 4 | |||
| pages = 100–102 | |||
| year = 2016 | |||
| month = September-October | |||
| doi = 10.13107/jocr.2250-0685.592 | |||
| pmid = 28164065 | |||
}}</ref><ref>{{Cite journal | |||
| author = [[Yuki Kotani]], [[Kenji Kubo]], [[Satoko Otsu]] & [[Toshihide Tsujimoto]] | |||
| title = Cephalic tetanus as a differential diagnosis of facial nerve palsy | |||
| journal = [[BMJ case reports]] | |||
| volume = 2017 | |||
| year = 2017 | |||
| month = January | |||
| doi = 10.1136/bcr-2016-216440 | |||
| pmid = 28108438 | |||
}}</ref><ref>{{Cite journal | |||
| author = [[Anisha Doshi]], [[Clare Warrell]], [[Dima Dahdaleh]] & [[Dimitri Kullmann]] | |||
| title = Just a graze? Cephalic tetanus presenting as a stroke mimic | |||
| journal = [[Practical neurology]] | |||
| volume = 14 | |||
| issue = 1 | |||
| pages = 39–41 | |||
| year = 2014 | |||
| month = February | |||
| doi = 10.1136/practneurol-2013-000541 | |||
| pmid = 24052566 | |||
}}</ref> | |||
===General Appearance=== | |||
*Severe [[Muscle spasm|muscular spasm]] (location varies with the type) | |||
**[[Opisthotonos]] | |||
**Leg [[extension]] with arm [[flexion]] | |||
**[[Risus sardonicus]] | |||
*May be in [[respiratory distress]] | |||
===Vitals=== | |||
*[[Fever]] | |||
*[[Tachycardia]] | |||
*Elevated [[blood pressure]] | |||
===Musculoskeletal=== | |||
*[[Spasms]] of the [[diaphragm]] and [[intercostals]] | |||
*Stiff [[abdominal wall]] | |||
===Respiratory=== | |||
*[[Tachypnea]] | |||
*[[Dyspnea]] | |||
* | ===Cardiovascular=== | ||
*Normal [[Heart sounds|S1 and S2]] | |||
*[[Hypertension]] | |||
*[[Cardiac arrhythmia|Arrhythmia]] | |||
===Autonomic=== | |||
* | *Intervals of | ||
**[[ | **[[Bradycardia]] and [[hypotension]] accompanied by of | ||
**[[ | **[[Tachycardia]] and [[hypertension]] | ||
===Abdominal=== | |||
*Stiffening of the [[Muscles of the abdominal wall|abdominal muscles]] | |||
The physical examination may vary according to the type of tetanus. Specific findings associated with the various types of tetanus may include: | |||
'''Local Tetanus''' | |||
*'''[[ | *Limited area of [[spasm]] | ||
** | *The affected area is in close proximity to a contaminated wound | ||
** | *Contraction is usually [[painful]] and associated with [[swelling]] | ||
*** | *Generalized tetanus may follow localized tetanus | ||
** | '''Cephalic Tetanus'''<ref>{{Cite journal | ||
** | | author = [[L. Weinstein]] | ||
| title = Tetanus | |||
| journal = [[The New England journal of medicine]] | |||
| volume = 289 | |||
| issue = 24 | |||
| pages = 1293–1296 | |||
| year = 1973 | |||
| month = December | |||
| doi = 10.1056/NEJM197312132892408 | |||
| pmid = 4270702 | |||
}}</ref><ref>{{Cite journal | |||
| author = [[Anisha Doshi]], [[Clare Warrell]], [[Dima Dahdaleh]] & [[Dimitri Kullmann]] | |||
| title = Just a graze? Cephalic tetanus presenting as a stroke mimic | |||
| journal = [[Practical neurology]] | |||
| volume = 14 | |||
| issue = 1 | |||
| pages = 39–41 | |||
| year = 2014 | |||
| month = February | |||
| doi = 10.1136/practneurol-2013-000541 | |||
| pmid = 24052566 | |||
}}</ref> | |||
*[[Ear infection]] or [[head]] injury may be seen | |||
*[[Trismus]] | |||
*Signs of [[Cranial nerves|CN III, IV, VI, VII and XII]] involvement including: | |||
**Tilting of the mouth | |||
**Inability to close the eye | |||
**Inability to move the tongue | |||
**[[Diplopia]] | |||
*Abnormal eye movements | |||
**[[Dysphagia]] | |||
*[[Confusion]] | |||
*Symptoms of [[Ischemic stroke history and symptoms|stroke]] | |||
'''Generalized Tetanus''' | |||
*Descending [[spasm]] | |||
*[[Trismus]] may present initially | |||
**Followed by [[Neck stiffness|stiffness of the neck]] | |||
**Difficulty in [[swallowing]] | |||
**Stiffness of [[abdominal muscles]] | |||
*Other symptoms include | |||
**Elevated temperature | |||
**[[Sweating]] | |||
**Elevated [[blood pressure]] | |||
**Episodic rapid [[heart rate]] | |||
*[[Spasms]] may occur frequently and last for several minutes | |||
*[[Spasms]] may continue for 3-4 weeks | |||
*Complete recovery may take months | |||
'''Neonatal Tetanus'''<ref>{{Cite journal | |||
| author = [[Martha H. Roper]], [[Jos H. Vandelaer]] & [[Francois L. Gasse]] | |||
| title = Maternal and neonatal tetanus | |||
| journal = [[Lancet (London, England)]] | |||
| volume = 370 | |||
| issue = 9603 | |||
| pages = 1947–1959 | |||
| year = 2007 | |||
| month = December | |||
| doi = 10.1016/S0140-6736(07)61261-6 | |||
| pmid = 17854885 | |||
}}</ref> | |||
*Unhealed, unhygienic [[umbilical]] stump | |||
*[[Trismus]] (spasm of [[masseter muscle]]) | |||
*[[Risus sardonicus]] (spasm of facial muscles) | |||
*Clenched hands | |||
*[[Dorsiflexion]] of the feet | |||
*[[Opisthotonus]] (spasm of spinal muscles) | |||
===The Spatula Test=== | ===The Spatula Test=== | ||
The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex attempting to expel the foreign object. | The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a [[gag reflex]] attempting to expel the foreign object. | ||
[[Image:Lock-jaw 2857.jpg|thumb| | [[Image:Lock-jaw 2857.jpg|thumb|left|150px|Lock-jaw in a patient suffering from tetanus.- '''[https://commons.wikimedia.org/wiki/File:Lock-jaw_2857.jpg Source:Wikimedia Commons]''']] | ||
[[Image:Neonatal tetanus 6374 lores.jpg| | [[Image:Neonatal tetanus 6374 lores.jpg|left|thumb|200px|An infant suffering from neonatal tetanus.- '''[https://commons.wikimedia.org/wiki/File:Neonatal_tetanus_6374.jpg Source:Wikimedia Commons]''']] | ||
<br style="clear:left" /> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Disease]] | |||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Neurology]] | |||
Latest revision as of 00:25, 30 July 2020
Tetanus Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Tetanus physical examination On the Web |
American Roentgen Ray Society Images of Tetanus physical examination |
Risk calculators and risk factors for Tetanus physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Tetanus initially presents with muscle stiffness. The distribution may vary with the type of tetanus. The masseter muscles are commonly involved with an accompanying headache. Neck stiffness, difficulty swallowing, generalized muscle spasms including the abdominal and back muscles and sweating may be seen later in the disease. In severe cases, respiratory paralysis may develop, which presents with apnea, hypoxia and hypercapnia.
Physical Examination
Tetanus initially presents with muscle stiffness. The distribution may vary with the type of tetanus. The masseter muscles are commonly involved with an accompanying headache. Neck stiffness, difficulty swallowing, generalized muscle spasms including the abdominal and back muscles and sweating may be seen later in the disease. In severe cases, respiratory paralysis may develop, which presents with apnea, hypoxia and hypercapnia.
Tetanus must be suspected in patients with:
- An injury involving contact of broken skin with contaminated environment, soil or dust.
- An absent or inconsistent history of immunizations.
Physical examination of a patient with tetanus may reveal the following:[1][2][3]
General Appearance
- Severe muscular spasm (location varies with the type)
- Opisthotonos
- Leg extension with arm flexion
- Risus sardonicus
- May be in respiratory distress
Vitals
- Fever
- Tachycardia
- Elevated blood pressure
Musculoskeletal
- Spasms of the diaphragm and intercostals
- Stiff abdominal wall
Respiratory
Cardiovascular
- Normal S1 and S2
- Hypertension
- Arrhythmia
Autonomic
- Intervals of
- Bradycardia and hypotension accompanied by of
- Tachycardia and hypertension
Abdominal
- Stiffening of the abdominal muscles
The physical examination may vary according to the type of tetanus. Specific findings associated with the various types of tetanus may include:
Local Tetanus
- Limited area of spasm
- The affected area is in close proximity to a contaminated wound
- Contraction is usually painful and associated with swelling
- Generalized tetanus may follow localized tetanus
- Ear infection or head injury may be seen
- Trismus
- Signs of CN III, IV, VI, VII and XII involvement including:
- Tilting of the mouth
- Inability to close the eye
- Inability to move the tongue
- Diplopia
- Abnormal eye movements
- Confusion
- Symptoms of stroke
Generalized Tetanus
- Descending spasm
- Trismus may present initially
- Followed by stiffness of the neck
- Difficulty in swallowing
- Stiffness of abdominal muscles
- Other symptoms include
- Elevated temperature
- Sweating
- Elevated blood pressure
- Episodic rapid heart rate
- Spasms may occur frequently and last for several minutes
- Spasms may continue for 3-4 weeks
- Complete recovery may take months
Neonatal Tetanus[6]
- Unhealed, unhygienic umbilical stump
- Trismus (spasm of masseter muscle)
- Risus sardonicus (spasm of facial muscles)
- Clenched hands
- Dorsiflexion of the feet
- Opisthotonus (spasm of spinal muscles)
The Spatula Test
The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex attempting to expel the foreign object.
References
- ↑ Mohamed Amirali Gulamhussein, Yueyang Li & Abhijit Guha (2016). "Localized Tetanus in an Adult Patient: Case Report". Journal of orthopaedic case reports. 6 (4): 100–102. doi:10.13107/jocr.2250-0685.592. PMID 28164065. Unknown parameter
|month=
ignored (help) - ↑ Yuki Kotani, Kenji Kubo, Satoko Otsu & Toshihide Tsujimoto (2017). "Cephalic tetanus as a differential diagnosis of facial nerve palsy". BMJ case reports. 2017. doi:10.1136/bcr-2016-216440. PMID 28108438. Unknown parameter
|month=
ignored (help) - ↑ Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter
|month=
ignored (help) - ↑ L. Weinstein (1973). "Tetanus". The New England journal of medicine. 289 (24): 1293–1296. doi:10.1056/NEJM197312132892408. PMID 4270702. Unknown parameter
|month=
ignored (help) - ↑ Anisha Doshi, Clare Warrell, Dima Dahdaleh & Dimitri Kullmann (2014). "Just a graze? Cephalic tetanus presenting as a stroke mimic". Practical neurology. 14 (1): 39–41. doi:10.1136/practneurol-2013-000541. PMID 24052566. Unknown parameter
|month=
ignored (help) - ↑ Martha H. Roper, Jos H. Vandelaer & Francois L. Gasse (2007). "Maternal and neonatal tetanus". Lancet (London, England). 370 (9603): 1947–1959. doi:10.1016/S0140-6736(07)61261-6. PMID 17854885. Unknown parameter
|month=
ignored (help)