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Seen in the ED Quiz: Shoulder Pain, X-ray Normal After Motor Vehicle Accident


After being cleared by paramedics at the scene of an accident where he was struck in an intersection, a young man comes to the ED in pain and barely ambulatory.

Patient history. A man in his 20s comes to the emergency department (ED) after he was hit by a car walking across an intersection with right thigh, knee, and calf pain, left calf pain and left shoulder pain. He was initially seen by paramedics who cleared him at the scene. He is coming to the ED now because his pain has significantly worsened in all areas and he can barely walk. He denies any neck or back pain, chest or abdominal pain, weakness, or other complaints

Vital signs. Pulse 94 beats/min; BP 96/61 mm Hg; RR: 18 breaths/min; afebrile

Physical Examination. Abdomen: Soft. There is no tenderness. No guarding or rebound. Lungs are clear but patient states his shoulder hurts when he breathes.
Musculoskeletal: Left shoulder is full range of motion and non-tender; compartments are soft.

Testing: X-rays of the knee and femur are normal. X-ray of the left shoulder is shown below.

What does the X-ray show?

  1. Anterior dislocation
  2. Posterior dislocation
  3. AC separation
  4. Normal Y-view

What finding is seen on the followup CT abdomen?

Splenic Injury from The Emergency Medicine 1-Minute Consult Pocketbook

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