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The patient is a 64-year-old man who presents with pain in his left shoulder after experiencing a fall in which the shoulder took the brunt of the blow. He is otherwise healthy.

View the image taken (Figure 1) and consider what your diagnosis and next steps would be.
Resolution of the case is described on the next page.

Clinical Challenge: January, 2011

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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