Clinical Challenge: April, 2010

In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected] The Case The patient is a 22-year-old male who fell and landed directly on his shoulder. On examination, you note marked local swelling and decreased range of …

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82-year-old man slips and takes a blow to his shoulder

The patient is an 82-year-old man who slipped on the street, experiencing a blow to his right shoulder. He has significant local swelling in the injured shoulder (specifically, over the acromioclavicular joint), as well as significantly limited range of motion. His distal pulses are normal. View the x-ray taken and consider what your diagnosis and next steps would be.

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82-year-old man injured from falling to his back

82-year-old man injured from falling to his back

The patient is an 82-year-old man who presents after having fallen backwards and landing on his back. He did not lose consciousness; nor did he vomit. The patient enters the clinic using a walker, which he reports using on a regular basis. Examination reveals an abrasion over his forehead and over the anterior right tibia. The neurological exam shows no acute changes. The patient is specifically tender over the shoulder, but there is no spiny …

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