Trust the Physical Exam

​BY ALI OZCAN, MD; AYUSH GUPTA, MD; ISABEL NEACATO, MD; DAVID DONALDSON, DO; &SHANNA JONES, MDA 17-year-old boy presented to the pediatric emergency department complaining of a right shoulder injury and right clavicular pain for two hours. The pain started after he checked another player into the boards while playing hockey. He had no head injury, loss of consciousness, or other trauma. He took 600 mg of ibuprofen with no relief, so he came to the ED.He had no past medical or surgical problems, and reported his pain as 4/10 over the clavicle region. His review of system was otherwise negative. The patient's vitals were within normal limits. He had tenderness over the medial side of the right clavicle and no visible deformity or crepitus. He had intact distal neurovascularity over the right upper extremity and normal breath sounds bilaterally. All other systems were normal.An x-ray of the right clavicle was negative for acute fracture. (Image 1.) The right clavicle appeared inferiorly displaced relative to the left. The patient was reevaluated, and was still complaining of pain despite receiving morphine. We ordered a CT without intravenous contrast of the sternoclavicular joint (SCJ), which revealed the diagnosis. (Images 2 and 3.)Image 1. The chest x-ray showing an inferiorly displaced right clavicle relative to the left may be positional.Images 2 and 3. CT of the sternoclavicular joint without contrast: Acute comminuted fracture involving the medial most right clavicl...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

Related Links:

Authors: Smolka S, Desai MY, Achenbach S Abstract The ISCHEMIA trial investigated two major principles in the therapy of coronary artery disease (CAD), i.e., symptom relief and improvement of prognosis. Specifically, it was designed to answer the question of whether, after ruling out left main stenosis, a routine interventional strategy in addition to optimal medical therapy can improve clinical outcome. Overall, this hypothesis could not be confirmed. Nevertheless, the trial yields interesting new aspects in the field of cardiac imaging. As a noninvasive diagnostic approach for individuals with suspected...
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
CONCLUSION: Breast ultrasound shows a high sensitivity to detect breast cancer during pregnancy. BCP is diagnosed at a higher stage than in nonpregnant women. In our series, patients with BCP had poorer outcomes than the not pregnant group. These results were not observed when adjusting for stage. PMID: 32623975 [PubMed - as supplied by publisher]
Source: Tumori - Category: Cancer & Oncology Tags: Tumori Source Type: research
CONCLUSION: The average cure rate with anthelminthic treatment is over 95%. Unfortunately, most treated patients in endemic areas become re-infected within months. Health education, personal hygiene, improved sanitary conditions, proper disposal of human excreta, and discontinuing the use of human fecal matter as a fertilizer are effective long-term preventive measures. Targeting deworming treatment and mass anthelminthic treatment should be considered in regions where A. lumbricoides is prevalent. PMID: 32628606 [PubMed - as supplied by publisher]
Source: Recent Patents on Inflammation and Allergy Drug Discovery - Category: Allergy & Immunology Tags: Recent Pat Inflamm Allergy Drug Discov Source Type: research
Authors: Ziemlewicz TJ, Hinshaw JL, Lubner MG, Knott EA, Willey BJ, Lee FT, Brace CL Abstract Purpose: The goal of this study was to compare intra-procedural radiofrequency (RF) and microwave ablation appearance on non-contrast CT (NCCT) and ultrasound to the zone of pathologic necrosis.Materials and methods: Twenty-one 5-min ablations were performed in vivo in swine liver with (1) microwave at 140 W, (2) microwave at 70 W, or (3) RF at 200 W (n = 7 each). CT and US images were obtained simultaneously at 1, 3, and 5 min during ablation and 2, 5, and 10 min post-...
Source: International Journal of Hyperthermia - Category: Internal Medicine Tags: Int J Hyperthermia Source Type: research
CONCLUSIONS: PCSK-9 is independently associated with triglycerides, Lp(a) levels, and HOMA-IR, but not LDL-C, in a relatively large general population sample. PMID: 32624555 [PubMed - as supplied by publisher]
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee. J Atheroscler Thromb. 2020 Jul 04;: Authors: Abola MTB, Golledge J, Miyata T, Rha SW, Yan BP, Dy TC, Ganzon MSV, Handa PK, Harris S, Zhisheng J, Pinjala R, Robless PA, Yokoi H, Alajar EB, Bermudez-Delos Santos AA, Llanes EJB, Obrado-Nabablit GM, Pestaño NS, Punzalan FE, Tumanan-Mendoza B Abstract BACKGROUND: Peripheral artery disease (PAD) is the most unde...
Source: Journal of Atherosclerosis and Thrombosis - Category: Cardiology Tags: J Atheroscler Thromb Source Type: research
Publication date: 15 September 2020Source: Life Sciences, Volume 257Author(s): Peng Peng, Bin Zhang, Jingyuan Huang, Cong Xing, Weixiao Liu, Chao Sun, Wei Guo, Shengyu Yao, Wendong Ruan, Guangzhi Ning, Xiaohong Kong, Shiqing Feng
Source: Life Sciences - Category: Biology Source Type: research
M2 macrophages reduce the radiosensitivity of head and neck cancer by releasing HB‑EGF. Oncol Rep. 2020 Aug;44(2):698-710 Authors: Fu E, Liu T, Yu S, Chen X, Song L, Lou H, Ma F, Zhang S, Hussain S, Guo J, Sun J, Yu P, Mao X, Wei L Abstract The aim of the present study was to examine the potential role of human heparin‑binding epidermal growth factor (HB‑EGF) secreted by M2 macrophages in the development of radioresistance in head and neck squamous cell carcinoma (HNSCC). Immunohistochemistry was used to detect radiosensitivity in human papilloma virus (HPV)‑positive and HPV‑negative HNSCC ti...
Source: Oncology Reports - Category: Cancer & Oncology Tags: Oncol Rep Source Type: research
In conclusion, the present results indicated that OMSCs may have a superior sensitivity to CKIP‑1 in promoting osteogenesis compared with BMMSCs; therefore, CKIP‑1 KO in OMSCs may serve as an efficient strategy for maxillofacial bone repair. PMID: 32626993 [PubMed - as supplied by publisher]
Source: Molecular Medicine Reports - Category: Molecular Biology Tags: Mol Med Rep Source Type: research
Effects of sacral nerve electrical stimulation on 5‑HT and 5‑HT3AR/5‑HT4R levels in the colon and sacral cord of acute spinal cord injury rat models. Mol Med Rep. 2020 May 15;: Authors: Zhu Y, Cheng J, Yin J, Yang Y, Guo J, Zhang W, Xie B, Lu H, Hao D Abstract Spinal cord injury (SCI) often leads to defecation dysfunction. Sacral nerve electrical stimulation (SNS) therapy could improve defecation function. The present study aimed to assess SNS therapy, with regard to the levels of serotonin (5‑HT) and its receptors (5‑HT3AR and 5‑HT4R) in the colon and sacral cord, a rat model of acute seve...
Source: Molecular Medicine Reports - Category: Molecular Biology Tags: Mol Med Rep Source Type: research
More News: Angiography | Back Pain | Blogging | Brain | Cardiovascular & Thoracic Surgery | Emergency Medicine | Gastroschisis Repair | Girls | Head Injury | Hospitals | Ibuprofen | Morphine | Neurology | Neurosurgery | Orthopaedics | Pain | Pediatrics | Physical Therapy | Pneumothorax | Post Traumatic Stress Disorder | Profits and Losses | Radiography | Rehabilitation | Spinal Cord Injury | Sports Medicine | Students | Study | Surgery | Thoracic Outlet Syndrome | Thrombosis | Tracheo-Esophageal Fistula | Ultrasound | Universities & Medical Training