Tetanus physical examination
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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 specific signs like trismus, that are used for a clinical diagnosis.
Physical Examination
Tetanus may initially present with muscle stiffness. The distribution may vary with the type of tetanus. Maseters are commonly involved initially with an accompanying headache. 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]
General Appearance
- Severe muscular spasm (varying with respect to 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
- S1 and S2 normal
Autonomic Dysfunction
- Intervals of
- Bradycardia and hypotension accompanied by of
- Tachycardia and hypertension
The physical examination may according to the type of tetanus. This includes:
- Local Tetanus
- Cephalic Tetanus
Various features of cephalic tetanus include:[4][5]
- Ear infection or head injury may be seen
- Trismus
- Patient may be staring in the air
- Signs of facial nerve involvement
- Tilting of the mouth
- Inability to close the eye
- May involve CN III, IV, VI, and XII
- Abnormal eye movements
- Dysphagia
- Confused patient with a stroke
- Generalized Tetanus
The generalized tetanus may show:
- Descending spasm
- Trismus 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
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
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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
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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)