Look Beyond the Surface

​"I have this older patient who fell on his buttock at home. He has shoulder pain even though he didn't come down on the shoulder, but he was diagnosed with adhesive capsulitis here within the past month. He has x-rays and is going to see the orthopedist this week. I was only going to x-ray the hips. What do you think?"​"Let me take a look," I said to my resident while pulling up the old images.The glenoid fossa was completely obliterated. The bony destruction seemed to have extended as far medially as the coracoid process. The joint space was also impressively widened.I cautioned the resident to think more broadly when the pain on the exam exceeds the history. This patient could have had a pathologic fracture, metastatic disease, or occult infection; he could have even been the victim of elder abuse. It is also possible for disease to evolve, changing the imaging in just a short time.The glenoid fossa was completely obliterated. The bony destruction seemed to have extended as far medially as the coracoid process. The joint space was also impressively widened.I cautioned the resident to think more broadly when the pain on the exam exceeds the history. This patient could have had a pathologic fracture, metastatic disease, or occult infection; he could have even been the victim of elder abuse. It is also possible for disease to evolve, changing the imaging in just a short time. The diagnosis: new metastatic cancer.​Tip to Remember: It isn'...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs