Foreign Bodies

General Information

Typical foreign bodies (FB) include implants used in surgery as well as more obvious foreign agents such as thorns, pencil leads, and bullets. The FB itself may be less of an issue than the material on or within it. An example would be a hollow-bore needle carrying a viral contaminant. Thus, the examiner considering the diagnosis and management of an FB should begin by identifying these key characteristics:

Does the agent contain or release noxious chemicals (e.g., lead, mercury, etc)?
Does the agent carry a potential infectious agent(s)?
Is the agent in a damaging or potentially damaging location?

Diagnostic Criteria

History

The patient usually recalls a direct injury. For example, a worker using a high-pressure paint gun will likely state, “I was using the ‘paint gun’ when it was bumped and touched my opposite hand. I felt a stabbing pain into my arm immediately.” In any work- or accident-related injury, the first examiner should carefully record the patient’s exact description of the incident. The examiner should not shorten or modify the patient’s version of events surrounding the incident in any material way. These initial statements are likely to enter a legal (as well as medical) record, and the impact of misstatements of the patient’s recollection can be embarrassing to the physician.

Occasionally, the initial problem will have occurred in the more distant past, and the physician must be more inquisitive to gain the pertinent information. Examples include delayed infection from a gun shot years previously and forgotten use of an implant for bone fixation or joint replacement.

The examiner should be certain to document the patient’s immune status, vaccination history, and routine medical history when acquiring initial information.

Physical Examination

Examination of the patient with an FB injury is often highly focused. After determining the patient’s history and completing a visual comparison of the affected versus normal extremity, the physician can focus attention on the “injured part.” In the case of an injection injury, the examination can be surprisingly benign. In such a case, the physician needs to carefully examine the soft tissue (fascial compartments, tendon sheaths). The key points regarding examination of any injection or FB injury are:

External appearance: Is a mass visible? Is erythema present? Is coloration equal to normal blood flow?
Pain: Is the pain localized? Does it vary with motion? Does it describe a normal nerve distribution?
Palpation: Is there a discrete area of tenderness or firmness or sharpness?
Range of motion: Is it full? What is the restriction? Is the restriction real or a result of pain?
Bone alignment or joint stability: Is the skeleton normal?

Changes in sensation or vascular flow can be the result of direct laceration by sharp objects such as glass shards or the result of an indirect dysfunction secondary to concussive force such as would occur from a gun shot wound (GSW) or bullet. Light touch examination and capillary refill are reliable screening methods for most patients.

All proximal lymph nodes should be examined if the FB may be infectious.

Only gold members can continue reading. Log In or Register to continue