"Episode 8"

"Show Notes"

"Posterior Shoulder Dislocation"

A middle-aged female presented with instant left shoulder pain following a throwing action.

Previous history of right shoulder dislocation.

There was no obvious loss of contour compared to the other shoulder.

Here is the X-rays showing posterior shoulder dislocation,

Post manipulatiopn X-ray

"Knee Dislocation"

A middle-aged male presented with a jiu-jitsu injury causing him severe knee pain.

Here is the knee X-ray,

This is a rare condition.

Why is it bad?

Management:

Reduce the knee under procedural sedation.
Apply long-leg POP.
Orthopedics admission.
Circulation should be checked repeatedly – damage may not be apparent for several hours.
Angiography is usually required.

"Teenage Leukaemia"

This was a teenager who presented with a two-week history of fever along with generalised body aches, loss of appetite, and weight loss.

The chest was clear.

The abdomen was soft and non-tender, with no organomegaly.

ENT examination showed: Throat to be hyperemic but with no pus.

Ears: NAD. No lymph node enlargement.

Vital signs: Unremarkable apart from unexplained Tachycardia (Afebrile and not in pain).

Because the patient was still tachycardic (unexplained),

The plan was:

Blood results came back with a surprise,

CRP:104 WBC: 5.8 Neutrophils: 0.58 Platelets: 95

Blood film: 57% blast cell (Suspected Leukemia)

Learning Points:

Never underestimate tachycardia in children especially if not well explained.
Consider other uncommon differential diagnoses for these cases like malignancy, Autoimmune diseases, etc.

Useful further reading: