Night Fight Aftermath

A patient in her early 20s came into the ED holding her right arm near her body with a complaint of right shoulder pain. She said she was punched in the shoulder during a fight the night before. Do you believe her story?     Checking the contour of the scapula reveals a cortical break in body. The undressed physical exam revealed ecchymosis and tenderness near the right scapula. The patient was told a fractured scapula requires more force than a punch, and she then added that she was thrown back against a metal pole during the fight. A CT scan confirmed the diagnosis.     Scapular fractures are uncommon, estimated to be only one percent of all fractures. Fractures of the body account for more than half of scapular fractures. Other fractures are those of the neck, glenoid, acromion, and the coracoid. A fractured scapula requires significant force, which demands the consideration of deeper injuries such as pulmonary contusions, pneumothorax, brachial plexus, and vascular injuries. It is also prudent to widen the physical evaluation to include head and abdominal trauma because the full mechanism of injury isn't usually isolated just to the scapula.   Most scapular fractures are treated conservatively with a sling and early mobilization, as in this case. Surgery tends to be reserved for those fractures that involve the joint or impinge on joint function. Examples of these include a large or displaced glenoid rim, displaced glenoid fossa fr...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Related Links:

Publication date: Available online 3 April 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Brajesh Kaushal, Sandeep Chauhan, Rohan Magoon, Nitish Naik, Ambuj Roy
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 3 April 2020Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Frederic J. Baud, Vincent Jullien, Philippe-Henri Secrétan, Pascal Houzé, Lionel Lamhaut
Source: Anaesthesia, Critical Care and Pain Medicine - Category: Anesthesiology Source Type: research
Conclusions: In the current study, the prevalence of depression among diabetic outpatients was higher than that of studies conducted in other settings. Depression was significantly associated with female sex, rural residency, type 2 diabetes mellitus, duration of illness> 6 years, high fear of complications, and poor social support. PMID: 32243106 [PubMed - as supplied by publisher]
Source: The Primary Care Companion for CNS Disorders - Category: Primary Care Tags: Prim Care Companion CNS Disord Source Type: research
Sufficient Lumbar Lateral Recess Decompression Acquired by Undercutting "Superior Articular Process Neck" Plus Intervertebral Disk Annuloplasty in Percutaneous Transforaminal Endoscopic Surgery. Med Sci Monit. 2020 Apr 03;26:e921119 Authors: Liu X, Peng Y, Pei L, Zhu Y Abstract BACKGROUND Percutaneous transforaminal endoscopic surgery has been used as a surgical measure for lumbar lateral recess stenosis. However, the necessary decompressive range has never been clearly documented in detail. Here, we discuss the effectiveness of a percutaneous transforaminal endoscopic procedure with clearly ...
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
CONCLUSIONS MRI appears to be a more accurate and reliable method than CT for depicting BT-IPMN. PMID: 32235820 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
CONCLUSION: The implementation of this questionnaire may reduce the incidence and morbimortality of opioid misuse among chronic pain patients and should improve chronic pain treatment in Portugal. PMID: 32238240 [PubMed - in process]
Source: Acta Medica Portuguesa - Category: General Medicine Tags: Acta Med Port Source Type: research
CONCLUSION: The current study showed that man gender, diabetes and hypertension were the greatest risk factors for PAD. We conclude that man patients with diabetes and/or hypertension should be put under serious consideration for routine CTA examination when under evaluation for LSS and intermittent claudication. PMID: 32242344 [PubMed - in process]
Source: J Korean Med Sci - Category: General Medicine Authors: Tags: J Korean Med Sci Source Type: research
CONCLUSION: The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community. PMID: 32242348 [PubMed - in process]
Source: J Korean Med Sci - Category: General Medicine Authors: Tags: J Korean Med Sci Source Type: research
[Primary Sjögren's Syndrome - News on Diagnostics and Therapy]. Praxis (Bern 1994). 2020;109(5):333-339 Authors: Sprecher M, Maurer B, Distler O Abstract Primary Sjögren's Syndrome - News on Diagnostics and Therapy Abstract. Primary Sjögren's syndrome is an autoimmune disease that affects primarily the exocrine glands and is mainly characterized by sicca symptoms of the eyes and mouth, but also nose, throat, vagina and skin can be affected. Fatigue and pain are also very characteristic. Systemic manifestations can occur, e.g. in joints, muscles, lungs, kidneys, skin or the nervous syste...
Source: Praxis - Category: General Medicine Authors: Tags: Praxis (Bern 1994) Source Type: research
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing.  BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive):  ST Elevation in...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
More News: Back Pain | Blogging | CT Scan | Depression | Emergency Medicine | Pain | PET Scan | Pneumothorax | X-Ray