Arshad Altaf Ajmal Agha, Syed Sharaf Ali Shah.
Unnecessary therapeutic Injections: A cause of physical disability.
Infect Dis J Jan ;10(2):22-3.
A 20-year-old unmarried female from outskirts of Sukkur came at the office of Sindh AIDS Control Program with difficulty in moving her right arm on April 24, 2001. According to the patient in first week of April she visited a local general practitioner (GP) because of complaints of generalized weakness. The GP advised a three weeks course of multi-vitamin injections to be administered intramuscularly (IM), one injection per day in different arms. More injections were administered in the right arm. The dispenser of the clinic used to administer the injection. She never noticed the procedure. After ten injections she started experiencing difficulty in moving her right arm and complained to the healthcare provider who concluded that the weakness has not improved and she should continue with the injections and she would be fine. When she could not move her arm the family decided to change their healthcare provider and visited numerous other GPs of the area. There was no improvement in her right arm`s condition. She was taken to Civil Hospital Sukkur from where she was asked to seek medical care in Karachi. She was referred to the Neurology department of Civil Hospital Karachi where she was diagnosed with advanced radial neuropathy secondary to unnecessary injections administered in her right deltoid region. On physical examination, besides not being able to move her right arm she was a healthy person with no history of any other illness or complains. She was distressed because of her inability to move the arm. Local exam revealed weakness and sensory deficit in the right arm. A nerve conduction and electromyography study was performed in the right upper extremity on April 26, 2001 at the department of Neurology of Civil Hospital Karachi. It demonstrated an advanced radial neuropathy, with normal nerve conduction in the median and ulnar nerves but absent motor and sensory responses in the radial nerve. Needle electromyography localized the lesion to a point distal to the radial nerve branch to the triceps muscle. The electrophysiological findings are consistent with radial nerve injury in the arm, possibly from direct injection-related mechanical trauma.
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