question-icon

I am a screenwriter, My current project involves a transradial

default
Posted on Wed, 27 Feb 2019
Question: I am a screenwriter, My current project involves a transradial amputee received their first prosthetic arm and I'm trying to think of a diagnosis that leads to amputation. I've read that PVD can lead to lower limb amputations. Despite its rarity in arms, I'm wondering if there's a possible instance in which it could lead to an upper extremity amputation.

So I have a few questions:

what are some symptoms of a severe case of PVD in the upper extremities? Moreover, at what point would treatments or something like a vascular reconstructive procedure not be an option? At said point, would amputation be the only way to assure the patient's safety?

The details filled out below in the health profile will be that of my character/patient
doctor
Answered by Dr. Anders Mark Christensen (1 hour later)
Brief Answer:
Atrial fibrillation or steroids

Detailed Answer:
Hi Spen.banfield,

There are several diagnoses, e.g. atrial fibrillation where a blood clot from the heart can get lodged in an artery in the arm. This will typically lead to pain, pallor, paresthesia, paralysis and pulselessness in the arm.

If the arm turns gangrenous, an amputation is imminent.

Other causes of an arterial thrombosis may be steroid use or hypertension that can lead to arterial dissection and ultimately the same symptoms and outcome as above.

Hope this helps.
Please let me know if you have further questions.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Anders Mark Christensen (2 days later)
So is this to say that the only case in which PVD leads to upper extremity amputation is when the arm turns gangrenous? Moreover, how severe must the gangrene be? Can gangrene be treated?

I am having trouble finding reference pictures of mild cases of gangrene. I guess what I'd like to know is how quickly it's physical symptoms can develop and whether a person could perceivably ignore it for a day or two.

Thank you for obliging me. I'm sure these are odd requests by any standard, but it's important that the medical aspects of the project are sound.
doctor
Answered by Dr. Anders Mark Christensen (22 hours later)
Brief Answer:
It can develop quickly

Detailed Answer:
Hi again,

Gangrene can develop quickly. It can be ignored for some time and be mistaken for something like cervical disc herniation. Usually, if a person is severely drugged for some reason or cognitively incapable of responding to the symptoms, gangrene can likely develop.

Please let me know if you have further questions.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
default
Follow up: Dr. Anders Mark Christensen (32 minutes later)
Last one. Just to wrap this up, I'd like to summarize what I think could happen to the character and I'd love to know if you think this is possible.

33 year old male diabetic, heavy smoker (2-3 packs a day) comes into hospital with a broken left arm: it's purple-black discoloured and in severe pain. He says that the arm had experienced some pain and numbnes for a couple weeks before, but after it was broken it became unbearable. Upon taking blood pressure of both his arms, we find the left has significantly lower blood pressure than the right. An ultrasound to the arm and angiogram detects a clot, a blood panel finds an infection in his bloodstream. It is at an advanced stage, and the safest way forward is amputation.

Does this seem right to you? What strikes you as not possible, malpractice, etc.?

Thank you again for your time. Is there a way I can write a comment or commendation on your behalf? I'm new to the site and am unsure of how I can show my appreciation.
default
Follow up: Dr. Anders Mark Christensen (2 minutes later)
One last thing: he woke up with discolouration in the arm, but said he thought it was an injury sustained in a boxing match the night before.
doctor
Answered by Dr. Anders Mark Christensen (19 hours later)
Brief Answer:
It sounds plausible

Detailed Answer:
Hi again,

It sounds plausible that the scenario you describe could lead to arterial occlussion and ultimately gangrene and amputation, especially if the person is socially deprived and unlikely to respond to symptoms of disease.

No need to show your appreciation in any specific way - you will have the opportunity to rate the answers with 1 to 5 stars.

Best wishes and best of luck with your project.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Anders Mark Christensen (4 hours later)
Thank you Dr. Christensen, I'll be sure to give a rating.
doctor
Answered by Dr. Anders Mark Christensen (5 hours later)
Brief Answer:
No problem

Detailed Answer:
No problem. Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Anders Mark Christensen

General Surgeon

Practicing since :2016

Answered : 1272 Questions

premium_optimized

The User accepted the expert's answer

Share on
I am a screenwriter, My current project involves a transradial

Brief Answer: Atrial fibrillation or steroids Detailed Answer: Hi Spen.banfield, There are several diagnoses, e.g. atrial fibrillation where a blood clot from the heart can get lodged in an artery in the arm. This will typically lead to pain, pallor, paresthesia, paralysis and pulselessness in the arm. If the arm turns gangrenous, an amputation is imminent. Other causes of an arterial thrombosis may be steroid use or hypertension that can lead to arterial dissection and ultimately the same symptoms and outcome as above. Hope this helps. Please let me know if you have further questions. Regards