EXAMINATION OF GANGLION

CLINICAL EXAMINATION OF GANGLION:

 

 

FOR DIAGRAM CHECK NORMAN BROWSE FIGURE 3.31 PAGE 80.

 

 

HELLO MR. BROWN. MY NAME IS DR. NAZISH. HOW ARE YOU FEELING TODAY? REPLY ACCORDINGLY.

 

DO YOU MIND IF I EXAMINE YOU.

 

THANK YOU. LET ME JUST DRAW THE CURTAINS TO ENSURE PRIVACY. MY HANDS ARE ALREADY WASHED.

 

COULD YOU PLEASE SIT ON THIS CHAIR AND ROLL YOUR SLEEVES UP. THE OTHER SIDE ALSO. AND NOW PLEASE PLACE BOTH YOUR HANDS PALMS UPWARDS ON YOUR LAP.

 

ARE YOU COMFORTABLE SIR.

 

I AM JUST GOING TO HAVE A LOOK FIRST OF ALL.

 

ACT:

 

COME CLOSE TO LEVEL OF LUMP AND LOOK FOR APPROXIMATE SIZE, SITE AND EXACT SIZE ALWAYS IN 2 DIMENSIONS, SHAPE, OVERLYING SKIN AND SURROUNDING SKIN.

 

TO EXAMINER:

 

THERE IS ON INSPECTION IN THIS GENTLEMAN A SMALL/ LARGE LUMP ON FLEXOR ASPECT OF WRIST JOINT JUST OVER DISTAL PART OF RIGHT FOREARM. IT IS 3 BY 2 CMS IN SIZE AND IS HEMISPHERICAL IN SHAPE. THERE IS NO EVIDENCE OF ANY REDNESS, SCAR IN THE OVERLYING SKIN AND THE SURROUNDING SKIN APPEARS TO BE NORMAL. THE CONTRALATERAL HAND APPEARS TO BE NORMAL.

 

TO PATIENT:

 

I AM NOW GOING TO GENTLY FEEL IT. IS IT TENDER? I WILL BE VERY GENTLE.

 

ACT:

 

CHECK TEMPERATURE WITH BACK OF HAND AND COMPARE WITH SURROUNDING SKIN. THEN TENDERNESS (LOOK AT APTIENTS FACE AND ALSO ASK IF IT IS TENDER), SURFACE, EDGE, CONSISTENCY, FLUCTUATION, COMPRESSIBILITY AND LAYER OF ORIGIN ALONG WITH LYMPH NODES.

 

TO EXAMINER:

 

THE OVERLYING SKIN IS NOT WARM. IT IS A NON TENDER LUMP WITH A SMOOTH SURFACE AND WELL DEFINED EDGE. IT IS FIRM IN CONSISTENCY AND IS NON FLUCTUANT AND NON COMPRESSIBLE.

 

TO PATIENT:

 

I AM NOW GOING TO PINCH THE OVERLYING SKIN AND MOVE THE LUMP IN 2 PLANES.

 

TO EXAMINER:

 

THE OVERLYING SKIN IS FREELY MOBILE AND THE LUMP FREELY MOVES OVER THE UNDERLYING TISSUES.

 

TO PATIENT:

 

COULD YOU PLEASE TENSE THAT MUSCLE AGAINST MY HAND. I AM GOING TO REASSESS THE MOBILITY OF LUMP IN 2 PLANES.

 

ACT:

 

IF LUMP IS ON FLEXOR ASPECT, PLACE YOUR HAND ON PALMAR ASPECT OF PATIENTS HAND AND PRESS DOWN NOW TELL PATIENT PLEASE BEND YOUR WRIST PUSHING AGAINST MY HAND.

 

IF LUMP IS ON EXTENSOR ASPECT, TELL PATIENT PLEASE GIVE ME YOUR HAND PALMS DOWNWARDS. NOW MAKE A FIST. TRY TO MOVE YOUR FIST BACKWARDS. DON’T LET ME PULL IT DOWN.

 

TO EXAMINER:

 

THE LUMP BECOMES MORE PROMINENT ON TENSING THE MUSCLE AND ITS MOBILITY IS NOT AFFECTED. THEREFORE IT ARISES FROM THE SUBCUTANEOUS TISSUES.

 

TO PATIENT:

 

THANK YOU SIR. YOU MAY ROLL DOWN YOUR SLEEVES NOW. LET ME HELP YOU WITH IT. THANK YOU AGAIN.

 

 

 

 

TO EXAMINER:

 

TO COMPLETE MY EXAMINATION I WOULD LIKE TO ASK THE PATIENT SOME QUESTIONS:

 

1. HOW THE GANGLION AFFECTS THEIR LIVES
2. WHETHER THEY HAVE NOTICED SIMILAR LUMPS ELSEWHERE
3. WHICH HAND IS DOMINANT KEEPING TREATMENT OPTIONS IN MIND?
4. WHAT IS THEIR OCCUPATION AGAIN KEEPING TREATMENT IN MIND?

 

THIS IS A GANGLION.

 

I WOULD LIKE TO WASH MY HANDS.

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