Those years when I hung up and upgraded in the hospital

Chapter 43: Improvement of Basic Medical Examination (Please collect and read)

"Doctor Fang, have you had breakfast?" Fang Yun was checking the new patients in bed 7 in his charge, and the old woman in bed 9 asked enthusiastically while holding the stump of the limb.

Her mood now is better than when she was first admitted to the hospital, and her grandson has come back to see her.

"Have eaten, Grandma Liu."

"Do you have a good appetite this morning?"

Before Fang Yun had time to look at the aunt in bed 7, he simply chatted a few more words and asked while watching bed 9 drink a large bowl of porridge and a pile of egg shells.

"Fortunately, I have a good appetite this morning, thanks to you, Dr. Fang. Otherwise, how could I eat so much."

"Dr. Fang, when can I get my prosthetic limb?"

"I want to get out of bed and walk." Grandma Liu asked.

"Then we have to wait until the wound is completely healed, which will take at least a month or two. Didn't Brother Zuo contact us to order a better prosthesis?"

"You can rest in peace." Fang Yun replied.

In the prosthetic limb market, there are some expensive ones and some cheap ones, depending on each person’s family background.

It has nothing to do with the doctor, and the customization of prostheses is not done in the hospital.

Seeing that Fang Yun ignored her when she came in, the aunt in bed 7 interrupted: "Doctor Fang, Grandma Liu has mentioned you to me more than once, saying that I am lucky to be under your care."

The aunt who spoke was in her fifties, slightly thin, but her skin was not as dark and pigmented as that of ordinary farm women, and she was relatively well-maintained.

Wearing a silk floral dress, she looks quite elegant. She must be someone from the system.

Fang Yun then said: "After the disease is cured and you are discharged from the hospital, you will be more blessed. What kind of blessing is it that you come to see a doctor? This is Grandma Liu being too flattering. Auntie, don't take it to heart."

"I'm here to do a physical examination on you."

As the number of patients in the department increased, the male and female wards were separated.

The patient in bed 7 has frozen shoulder, also known as frozen shoulder, which mostly occurs in women around 50 years old.

However, Fang Yun does not agree with the diagnosis of frozen shoulder. This diagnosis has been abandoned for a long time. Nowadays, it is rarely used in teaching hospitals. If this is the next diagnosis of frozen shoulder, it will be diagnosed by superiors. scolded.

However, Longxian People's Hospital is still in use.

After a physical examination, the symptoms were indeed very similar to the classic "frozen shoulder".There are tender points in front of the shoulder joint, and the active and passive movements of the shoulder joint are limited.

There was no obvious history of trauma, and the corresponding diagnosis of rotator cuff injury was basically not considered.

Due to limited movement and activity functions, some specialist physical examinations of the shoulder joint are not practical.

However, after completing this physical examination, Fang Yun discovered that his basic medical examination had quietly been upgraded from level 2 to level 3.

After the upgrade, the thin layer of window paper seemed to have opened something, but Fang Yun had not yet had time to realize the subtle changes.

The physical examination of this patient did not have much effect.

"Auntie, I've finished the physical examination. Let's not be in a hurry. I'll take a look at your film first and try to figure out the diagnosis."

"You have applied so many medicinal wines before, but there is no relief?" Fang Yun asked as he said it.

It is difficult for Fang Yun to comment on whether the medicinal wine is effective, but there is indeed pigmentation on the outside of this aunt's left shoulder joint, and the skin has a tendency to harden locally.

"Oh!~"

"Apply a lot, I've tried all kinds of home remedies, prescriptions, and plasters, but they're of no use."

"Occasionally there will be relief, but after a while, it will be the same as before." The aunt sighed. Obviously, she had thought of many ways to deal with this matter, but she had no choice but to come to the hospital. Choose surgical treatment. "I haven't applied it for a while now. The concepts of Chinese medicine and Western medicine are different. I don't understand the relevant theories of Chinese medicine. But if you continue to apply medicinal wine, it will make the local skin sensitive and increase the risk of infection."

"Since we have chosen surgical treatment, we'd better not apply medicinal wine yet." Fang Yun explained.

If she had to apply medicated wine, then the operation would not be possible, and the chance of subsequent infection would be extremely high. So which surgeon would dare to do it and cause such trouble?Why bother?

"No more wiping," the aunt replied quickly.

But after Fang Yun focused his attention on the MRI of her shoulder joint, he frowned tightly.

The traditional diagnosis of frozen shoulder has been abandoned. In fact, there are more accurate diagnoses, such as rotator cuff injury, acromion impingement syndrome, shoulder joint synovial hyperplasia, synovial plica; or subacromial bursitis, etc. substitute.

But when Fang Yun read the film carefully, he didn't find these things.

This aunt, although there are synovial folds in the shoulder joint cavity, there are no corresponding indications such as bursitis.

This kind of reading is not difficult for Fang Yun, who has level 3 MRI reading skills.

In addition to the acromion, this aunt’s acromion is not the type 2 or type 3 acromion in shoulder impingement syndrome. So what’s going on?

What are her symptoms?

Is there something you haven't noticed yet?

"Doctor Fang, how does this film look like? Is it frozen shoulder?" Auntie asked Fang Yun after watching it for a while.

Fang Yun thought for a moment and asked cautiously: "Auntie, I have to look into the diagnosis carefully. As you know, I don't have as deep skills as the director."

"I can only follow the diagnosis made by the director and take my time."

If you want to confirm a diagnosis in clinical practice, it is easy, just find the corresponding point.But if you want to overturn the superior's diagnosis, you can't just say it with your mouth. You still have to find corresponding evidence.

Who admitted this, why was he diagnosed with frozen shoulder, and what should he do after he was admitted?
This is a problem.

Therefore, Fang Yun had to see what was written on the hospitalization certificate and what diagnosis was written on it.

Of course, before that, Fang Yun still had to carefully retrieve the films in the film viewing system in order to see more aspects.

The aunt was stunned when she heard this, but immediately smiled and said, "Dr. Fang, you are so humble."

"Auntie, let me do a physical examination for you again." Fang Yun smiled and put away the film first.

Immediately afterwards, Fang Yun tested the Tinel sign!
If no corresponding damage can be found at the anatomical level, then you have to look for other problems, such as nerves.

The Tinel sign refers to percussion of the nerve injury (only mechanical force injury) or the nerve damage site or its distal side, and the occurrence of discharge-like numbness or ant walking sensation in the dermatome dominated by it is positive, indicating damage.

However, after Fang Yun finished it, he still felt that there was no problem.

At this moment, Fang Yun felt bad all over, and his expression changed slightly.

I thought to myself: "What is the cause of shoulder joint pain?"

Do you want to play such a high-end game?
Could you please give me some anatomical instructions, such as a rotator cuff injury or something, pointing directly to her functional pathology?

"I don't feel anything, not the numbness you mentioned." Auntie said firmly.

"Okay, it's okay. It's better not to have it, right?"

"That's it for now, I'll go see another new patient." Fang Yun smiled back.

(End of this chapter)