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The patient is an 82-year- old man who slipped on the street, experiencing a blow to his right shoulder. He has significant local swelling in the injured shoulder specifically, over the acromioclavicular joint as well as significantly limited range of motion. His distal pulses are normal.

View the x-ray 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: October, 2008

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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