In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with.

If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected] The patient is a 22-year-old male who fell and landed directly on his shoulder. On examination, you note marked local swelling and decreased range of motion.

View the image taken (Figure 1) and consider what your diagnosis and next steps would be.

Figure 1.

Resolution of the case is described on the next page.

Clinical Challenge: April, 2010

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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