The genius doctor starts from the game

Chapter 21 Crouching Tiger, Hidden Dragon's Intern
In fact, Pang Lin was very upset. In terms of grades, he was definitely better than Zuo Liwei and Chang Guangkun.

However, Zuo Liwei has connections. Although he is not as successful as Chang Guangkun, Zuo Liwei occupies the two options of performance and connections. Therefore, he has the greatest possibility of obtaining a direct scholarship.

But when it comes to foundation and achievements, Pang Lin is confident that he will be better than Zuo Liwei.And he never gave up on that rivalry.

At this moment, upon hearing Wang Xiaoyang's question, Pang Lin hesitated for a moment before answering:

"I agree with Brother Chen's diagnosis."

"From the medical history that my brother just mentioned, we know that the patient now has two major symptoms of shoulder joint pain and limited mobility, whether it is rotator cuff injury or acromial impingement. This situation can occur. Pain and limited mobility are also symptoms of shoulder Typical presentation of cuff injury and acromial impingement syndrome."

This sentence is not brilliant, and it even sounds like a panacea, but immediately after, Pang Lin started to analyze one by one.

"Brother Chen's physical examination just now pointed out the tenderness in the front and the anterolateral side. We can remember these two positions. Then, Senior Brother Chen said that the Napoleon's sign was positive, which means that the rotator cuff, subscapularis muscle Injury to the infraspinatus and the infraspinatus makes the patient's internal rotation function limited, so they will show positive signs of Napoleon's sign."

"Following that, the patient's Jobe's sign and O'Brien's test were also positive, which indicated possible damage to the infraspinatus and teres minor, which limited internal rotation."

"And the patient's pain arc also shows that the patient has pain during the activity, which just verifies the symptoms of rotator cuff injury."

"We all know that when the supraspinatus is injured, it is just in front, so there will be anterior and anterolateral tenderness, so we consider that the patient's supraspinatus injury will be more severe."

"The reason why the supraspinatus is seriously injured is that the acromion impinges, which leads to the narrowing of the subacromial space, and the shape of the supraspinatus is just on the spine of the scapula, and the variation of the acromion will cause the wear of the tendon of this muscle, so The damage was more severe."

Pang Lin's words directly made Chen Zhuoyuan, who was watching the film, lose his legs and looked at Pang Lin with squinted eyes.

Because Pang Lin's words were so detailed that he couldn't even say them, and he analyzed the reasons so systematically. This level was simply beyond his expectation.

Is this really the level that an intern should have?
Not only Chen Zhuoyuan, but also Liu Jun and Li Hui couldn't help but glance at Pang Lin several times.
Obviously, Pang Lin's analysis was slightly beyond their expectations, but they didn't say much.

As for Cheng Cheng, a doctor in training, and other regular trainees who are not majors in orthopedics, they all looked confused. They just felt that Pang Lin's words were very profound and lofty, and felt that this intern was simply a freak. His way of explaining , as if they had seen the superior physician.

This is not a serious intern, or he is a master of learning.

Zuo Liwei frowned suddenly, because it seemed that Pang Lin's analysis went beyond his knowledge structure and structure, so that he could not add anything, and he felt like an enemy to Pang Lin.

Perhaps, the biggest threat is not Chang Guangkun, but this Pang Lin, who hides very deeply.

Chang Guangkun raised his brows and touched his ears. He was very open-minded. Whether he can get this direct blog post depends entirely on the old man, regardless of whether it is Zuo Liwei or Pang Lin. Just take it, if you can’t, just go to the next Zhibo station.

But he reckons that he has the best chance of getting a direct blog post. After all, if Professor Wang wants to go further, he may still need some help from his family.

After thinking about it this way, Chang Guangkun saw Professor Wang's gaze focused on him again, and said with a sneer, "I think Pang Lin is right, it is rotator cuff injury and acromial impingement syndrome."

These were the two important points he had just tried to remember.As for why it was rotator cuff injury and acromial impingement syndrome, that was not what he, an intern, should consider.

When Professor Wang looked at Zuo Liwei again, Zuo Liwei also said: "I also agree with Pang Lin, he has already analyzed it in great detail."

Professor Wang didn't look at Lu Cheng again, because Lu Cheng felt in his heart that he was inferior to Pang Lin and Zuo Liwei. Since Zuo Liwei didn't have any other opinions, it is estimated that from Lu Cheng, there is nothing better to add. out of place.

Now that Chen Zhuoyuan finished watching the MRI, he said with a slightly naive smile: "This junior brother Pang has a very solid foundation, and he basically confused the patient's symptoms without reading the scans, which requires a strong foundation. "

Professor Wang Xiaoyang took the NMR over to have a look, and Li Hui and the others seemed to have nothing to add, so they went over to watch the film, after all

The first person has already said what should be said, how else do we need to make a diagnosis?

However, after watching the film, Professor Wang Xiaoyang and Professor Liu Jun came and put down the NMR with general interest, and then distributed it to others to watch.

Pang Lin first took over the film from Professor Wang Xiaoyang, and then Zuo Liwei and others took the films of other levels into their hands, as if they were pondering over and over again, combining what Pang Lin said before.

"Let's take a look, is there anything else to add?" Professor Wang Xiaoyang suddenly said to everyone.

Li Hui took a look at Lu Cheng and found that Lu Cheng was behind the crowd and didn't even have a chance to watch the film, so he simply gave him the film.

Lu Cheng just glanced at it for a while, then frowned slightly, and then looked at several levels, and seemed to find something wrong again, which was slightly different from what he saw in the textbook yesterday.

So Lu Chenggong touched his head, and seemed to be conducting the final verification and self-argument. After all, Professor Wang Xiaoyang had acquiesced to Pang Lin's statement before. It may be that he has not cleared up the confusion and clarified the differential diagnosis, but , the more he watched the film now, the more confused he became.

Faced with the constant nodding of the crowd who seemed to be proving Pang Lin's statement, Lu Cheng's pats on the head looked very different.

Professor Wang Xiaoyang asked, "Does Lu Cheng want to say something?"

Lu Cheng saw that Wang Xiaoyang still named himself, thought for a while, and met Li Hui's encouraging gaze, so he said, "Professor Wang, let me just tell you what I think."

"First, the patient's current main symptoms should be pain and limited active activities, but his passive activities are not limited. Therefore, I think there may be no shoulder impingement. Of course, we did not It is not easy to make a final judgment after seeing the Y-bit plain film."

"However, in the several physical examinations done by Senior Brother Chen just now, we can all find that although the resistance muscle strength of the patient has declined in all aspects, they all exist, which proves that the integrity of the tendon may not be a big problem. Yes, but the patient is still in pain.”

"So we may need to look elsewhere."

"Combining with the positive pain arc of the patient's final physical examination, the patient's abduction can reach more than 110°, which proves that the patient's abduction function is intact,"

"In addition, we can also see that although Jobe's sign and O'Brien's test are also positive, they are only weakly positive. This weakly positive is reflected in patients with rotator cuff injuries, which is not a problem. However, the patient's muscle There was no significant decrease in power,

"Again, the Jobe sign and O'Brien's test were only weakly positive. Although this may be because the injured tendon is not on the infraspinatus and teres minor, it may not be caused by the tendon injury at all, but by the whole body. The range of motion within the shoulder joint itself is limited."

"Combined with the patient's age, I think the main diagnosis of this patient should be considered as: frozen shoulder! It is also called fifty shoulders. It also happens to be more appropriate for the patient's age."

"And apart from this frozen shoulder, the patient has no loss of the rotator cuff, but she has damage to the labrum, especially above the labrum."

"Professor Wang, take a look at this level. There are high white shadows on the top of the labrum from front to back, which proves that the patient has damage to the SLAP that Teacher Li Hui told us yesterday. So I think that the second diagnosis may be SLAP damage."

"Third point, although we can see white spots on the tendons of the supraspinatus, infraspinatus, subscapularis and teres minor, these may be synovial hyperplasia in the subacromial space after MRI The remaining image does not mean that there is a problem with the integrity of the rotator cuff tendon at this position."

"This is my opinion."

When Li Hui heard half of it, his eyes widened for a while.Then he immediately retracted his expression.

As for Liu Jun, because he said just now that this case might be difficult for Chen Zhuoyuan and the others, he said a little embarrassedly: "Well, I underestimated the current students and interns, who emerge in endlessly like Crouching Tiger, Hidden Dragon. One is better than the other."

(End of this chapter)