Suggest Treatment For Swelling In Hand After Failure In Placing Stent

Posted on Mon, 6 Apr 2015

Question: I have done angioplasty for blockage of one vein 25 days ago. Doctor tried to put the stent through hand but could not do. Reason is not informed to me. Then he tried from leg as common practice and made successful. During the effort from hand there was lot of bleeding. As a after effect there was high swelling on hand and few of my fingers were not working. After few days swelling is reduced but i lost sensation on thumb and adjacent fingers. More over it continuously pains and disturbing to sleep or to work. Doctor says you continue to apply 'Thrombophob' it will be ok. I am worried to loose the fingers sensation permanently. I seek your advice and further treatment. My detais are as under.

XXXX. Age 58 years. Weight 84kgs, Height: 178cms

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
please send a marked photo / take second opinion of a Neurologist.

Detailed Answer:
Hi.
Thanks for your query.
I have read and understood the history and your concerns.

The first attempt is made through the radial artery above the wrist. This may fail if the size of the artery is not sufficient to pass the cannula and the catheter. Due to the bleeding at the wrist there might have been swelling, edema at the wrist compressing the nerves supplying the affected part.
After a few days the swelling was reduced but you lost sensation on thumb and adjacent fingers. It looks there is continuous and disturbing pain at the wrist.

My thoughts:
The neurological problem was either due to the pressure of the hematoma at the wrist or due to the needle prick at the same site.

May I please know a few details?
- Please tell me the exact are of loss of sensation on thumb and fingers. You may please mark the area with ''blue marker'' / pen and take a picture (photo) and post with this query.
Also mark the painful area with ''red mark'' and post a photo as YYYY@YYYY
This will help me to suggest you more.

Till then continue the treatment as advised by your Doctor.
I hope you must have taken a second opinion of a Neurologist; if not take one.

I hope this answer helps you to get a proper diagnosis, and get a proper further treatment. Please feel free to ask for more or if you need further clarifications if you feel there is a gap of communication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (48 minutes later)

Thanks for the analysis and advice on my problem. As required I am sending photographs duly marked, where there is no/little sensation. The pain is on thumb top, first finger and second finger. I M not able to sleep properly. Also there is no sensation on back of last finger as marked. The pain in the arm is reduced to 90 %. but not reduced in the fingers.
I don't find any system for attachment with this. So tring to send photo by separate mail.
XXXX

Answered by Dr. T Chandrakant (44 minutes later)

Brief Answer:
Nerve conduction studies under Neurologist's opinion and Rx

Detailed Answer:
Thanks a lot for a nicely marked pictures, seen both.
The one towards the thumb are supplied by the Median nerve and must have been caused by the pressure of the hematoma that extended into the carpal tunnel. The loss of the sensation on the side and back of the little finger side is due to the ulnar nerve- this too passes neat the carpal tunnel again might have been die to the pressure of the hematoma.
What wonders me is the pain on the thumb top, first finger and the second finger.
It is to be seen as a sign of recovery or not is the question. The small nerves can show altered sensation during the recovery period.

I would advise you to have a consultation of a Neurologist and go for the nerve conduction studies. This will help us to know the status of the nerve damage and will help to monitor the recovery course.

Some medicines like Gabapentin / Pregabalin or Amitryptilin or Tegritol help to control the disturbing pain. Since these are prescriptions medicines you have to discuss with your Doctor / Neurologist to get a valid prescription.

I hope this answer helps you.

(You may please rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant )

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (1 hour later)

Thanks Doctor again for your valuable guidance and recommendations. I am satisfied with your quick and to the point response.
If needed I will come back to you after consulting neurologist next week.
For your information my son is in final year orthopedics.
Regards
XXXX

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
Thanks for your appreciation.

Detailed Answer:
Sure, you are most welcome.
This is a great news that your son is in final year Ortho. He too shall be of great help.

Take care.
Please give feedback.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar