Tetanus physical examination: Difference between revisions
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*'''Cephalic Tetanus''' | *'''Cephalic Tetanus''' | ||
Various features of cephalic tetanus include:<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]] | | author = [[Anisha Doshi]], [[Clare Warrell]], [[Dima Dahdaleh]] & [[Dimitri Kullmann]] | ||
| title = Just a graze? Cephalic tetanus presenting as a stroke mimic | | title = Just a graze? Cephalic tetanus presenting as a stroke mimic | ||
Line 75: | Line 84: | ||
| pmid = 24052566 | | pmid = 24052566 | ||
}}</ref> | }}</ref> | ||
**Involves [[cranial nerves]] of face | |||
**Rare form that may follow [[ear infections]] or [[head]] injury | |||
**Trismus | |||
**Stare in the air | |||
**Involves [[cranial nerves]] of face, most commonly facial nerve | |||
***Other nerves involved include CN III, IV, VI, and XII | |||
**Dysphagia | |||
**May be confused with stroke | |||
*'''Generalized Tetanus''' | *'''Generalized Tetanus''' | ||
The generalized tetanus may show: | |||
** | **Descending spasm | ||
** | **[[Trismus]] is the initial presentation | ||
***Followed by stiffness of the neck | ***Followed by stiffness of the neck | ||
***Difficulty in [[swallowing]] | ***Difficulty in [[swallowing]] | ||
Line 94: | Line 110: | ||
*'''Neonatal Tetanus''' | *'''Neonatal Tetanus''' | ||
Various features of neonatal tetanus include:<ref>{{Cite journal | |||
| author = [[Martha H. Roper]], [[Jos H. Vandelaer]] & [[Francois L. Gasse]] | |||
*** | | title = Maternal and neonatal tetanus | ||
** | | journal = [[Lancet (London, England)]] | ||
**Very rare | | 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 may be seen | |||
**Trismus (spasm of masseter muscle) | |||
**Risus sardonicus (spasm of facial muscles) | |||
**Clenched hands | |||
**Dorsiflexion of the feet | |||
**Opisthotonus (spasm of spinal muscles) | |||
**Very rare | |||
===The Spatula Test=== | ===The Spatula Test=== |
Revision as of 22:35, 2 June 2017
Tetanus Microchapters |
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Tetanus physical examination On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.
Overview
The diagnosis of tetanus is completed through a physical examination. Tetanus infection produces some very clear symptoms that will be used for a clinical diagnosis.
Physical Examination
Tetanus may initially present with stiffness of muscles. Jaw muscles i.e the maseters are most commonly involved initially along with headaches. Neck stiffness, difficulty swallowing, spasms involving various muscles groups including the abdominal muscles and sweating may be seen later in the disease. Physical examination of tetanus may also lead to the following:[1][2][3]
- Fever
- Autonomic dysfunction
- Intervals of bradycardia and hypotension accompanied by of hypertension and tachycardia may be seen later in the disease.
- Severe cases of tetanus may show:
- Opisthotonos
- Extension of the legs, flexion of the arms
- Spasms of the diaphragm and intercostals leading to episodes of apnea
- Rgid abdominal wall
The physical examination can reveal a few different forms of the infection. These include:
- Local Tetanus
- Uncommon
- Anatomic area is similar to the injured area
- Contraction of the muscles localized initially
- Contraction is usually painful and swelling
- Contractions may last for weeks before subsiding gradually
- Generalized tetanus may follow localized tetanus
- Cephalic Tetanus
Various features of cephalic tetanus include:[4][5]
- Rare form that may follow ear infections or head injury
- Trismus
- Stare in the air
- Involves cranial nerves of face, most commonly facial nerve
- Other nerves involved include CN III, IV, VI, and XII
- Dysphagia
- May be confused with stroke
- Generalized Tetanus
The generalized tetanus may show:
- Descending spasm
- Trismus is the initial presentation
- Followed by stiffness of the neck
- Difficulty in swallowing
- Rigidity 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 continue for 3-4 weeks
- Complete recovery may take months
- Neonatal Tetanus
Various features of neonatal tetanus include:[6]
- Unhealed, unhygienic umbilical stump may be seen
- Trismus (spasm of masseter muscle)
- Risus sardonicus (spasm of facial muscles)
- Clenched hands
- Dorsiflexion of the feet
- Opisthotonus (spasm of spinal muscles)
- Very rare
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)