Churchills Pocketbook of Differential Diagnosis

B978-0-7020-3222-6.00005-5, 00005
31
SUBASH KC/NMC-15TH/2014
Arm Swellings
Swelling may be localised or generalised. Localised swellings may be
related to joints or fractures. Localised swellings around joints are
covered in the section on joint disorders (p. 250). This section includes
only those conditions that may cause generalised swelling of the arm.
CAUSES
• Trauma
Infection
• e.g. cellulitis, lymphangitis
Axillary vein thrombosis
• Lymphoedema
• Congenital
•
• Acquired
Axillary node lesions
• Carcinoma
• Infection, e.g. filariasis
• Excision
•
• Radiotherapy
Other
• Reflex sympathetic dystrophy (Sudek’s atrophy)
HISTORY
A history of trauma will be obvious in many cases, although
pathological fractures may occur with little trauma. Reflex
sympathetic dystrophy may follow trauma, e.g. Colles’ fracture.
Congenital lymphoedema of the arm is rare; however, secondary
lymphoedema is not and a history of carcinoma of the breast,
operations on the axilla or radiotherapy to the axilla should be
sought. There may be a history of a puncture wound or flea bite,
suggesting cellulitis or lymphangitis. Streptococcal cellulitis is
common following puncture wounds in patients who already have
lymphoedema of a limb. Axillary vein thrombosis may come on
after excessive or unusual exercise and has been nicknamed ‘effort
thrombosis’. An example is a patient who has been painting a ceiling
who is not used to doing that sort of thing. It may occur in patients
with cervical ribs or thoracic inlet obstruction. Thrombosis may also
occur following insertion of a central line.
EXAMINATION
There may be localised swelling and tenderness together with
crepitus associated with a fracture. There may be generalised
Section A