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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 19-year-old male who complains of pain after receiving a blow to the shoulder.
Range of motion is limited due to pain. The patient is otherwise healthy.

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

Clinical Challenge: November, 2009

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services