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| IMAGE QUIZ ARCHIVE | ||||||
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Image Quiz A Missed Diagnosis1 | ||||||||||
 Fig. 1. Initial anteroposterior radiograph of the left shoulder. For larger view place cursor on image | A twenty-two-year-old man was seen in the emergency department of a large hospital after he was involved in a motorcycle accident. The patient was managed for multiple injuries, including a head injury with loss of consciousness, amnesia, impairment of hearing, and numbness on the left side of the face; fractures of the ribs, the right foot, and the ankle; and lacerations of the left foot. He also reported pain in the left shoulder. A diagnosis of a possible fracture of the left scapula was made on the basis of an anteroposterior radiograph of the left shoulder. The left upper limb was immobilized in a sling, and the patient was discharged from the hospital after ten days. | |||||||||
| Approximately two weeks after the accident, the patient was assessed by an orthopaedic surgeon because of continued pain in the left shoulder. A repeat anteroposterior radiograph was interpreted as showing a possible acromioclavicular disruption. The patient was advised to continue to wear the sling and to begin early passive range-of-motion exercises as tolerated. | ||||||||||
| Six days later, the patient consults you. | ||||||||||
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What further radiographic examinations would you like to see? | ||||||||||
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