Chapter 65: Director Lin The Carnivore!
The girl’s brows furrowed slightly upon hearing this. “Doctor Lu, can you really figure out so much just from a physical examination?”
“Hmm… some conditions can be identified through a physical examination, while others cannot. Your situation is rather unique, so I can make a guess by gathering some preliminary information.”
“It’s not a definitive diagnosis yet.”
After replying, Lu Cheng washed his hands with hand sanitizer and walked to the computer to read the images. He asked again, “Why do you ask? Are you in the industry?”
“My wife works at Longfeng Maternity Hospital!” the man said with a somewhat awkward expression.
The girl immediately said, “Doctor Lu, I’m a nurse.”
Lu Cheng immediately responded, “You’re from nursing, so communication will be even better. The physical examination is for guessing; definitive diagnosis relies on comprehensive information.”
“Let’s talk after I see the film! Give me your medical record book.” Lu Cheng’s voice became more mature and steady.
The patient nodded, signaling her boyfriend to pass the medical record book over. “Okay.”
However, her eyes darted around again, and after blinking, she asked, “Doctor, isn’t joint dislocation something an orthopedic doctor handles? You’re in the emergency department, and you handle this too?”
As she spoke, the girl sat down on a wooden stool with peeling yellow paint, her brow furrowed with lingering doubt.
“I used to be in orthopedic standardized training. Joint dislocation is an emergency condition and isn’t strictly classified under one specific department.”
“Of course, we also called the orthopedics department. The orthopedic doctor on duty today said he couldn’t handle your joint dislocation.”
“Naturally, you can also be referred to other hospitals after my diagnosis is confirmed, such as a Traditional Chinese Medicine Hospital or the Zhou People’s Hospital,” Lu Cheng said.
Patients have the right to informed consent and the right to refuse treatment. The more someone is in the industry, the more their rights should be respected.
Tian Zhuang had already found the patient’s films. However, his skill level only allowed him to see the dislocation, and knowing he wasn’t good with words, he didn’t say much…
Plain films are primarily used for initial screening to rule out fractures and to confirm if the bone alignment is normal.
They are a relatively simple auxiliary examination.
Lu Cheng looked for about a minute and a half, scanning the most critical areas, and then explained to Tian Zhuang, “Tian Zhuang, look here. The humerus, ulna, and radius bone lines are intact; there are no fracture lines or deformities.”
“The humerus and glenoid fossa are separated in alignment. The humerus is located below the coracoid process, indicating an anterior dislocation.”
“You can see the joint capsule is not dislocated. The acromioclavicular joint space is narrowed; it’s not a grade two injury, but falls within the scope of a grade one injury.”
“In such a situation, after reduction, we can perform a physical examination to assist in diagnosing a rotator cuff tear.”
Lu Cheng’s words were logical and professional, but the subspecialty span was a bit too wide, leaving Tian Zhuang completely bewildered and with a conflicted expression.
He didn’t have a strong understanding of orthopedics, let alone subspecialties like joint dislocation.
Despite not understanding completely, he patiently followed Lu Cheng’s explanation, carefully trying to read and comprehend as much as he could.
Lu Cheng, however, didn’t dwell on it and proactively started writing the medical record after finishing his explanation.
…
However, midway through Lu Cheng writing the medical record, a voice interrupted, “Xiao Lu, what do these English words you’re writing mean?”
Hearing this, Lu Cheng immediately looked up. “Director Lin, what brings you here?”
After asking, Lu Cheng felt a bit ‘amateurish.’ Why else would he be here? It must be the big brothers in orthopedics who called Director Lin over.
Upon hearing Lu Cheng mention Director Lin, the girl and the man’s expressions brightened, and they once again recounted their “brief medical history” to Lin Qianlong.
Lin Qianlong smiled and explained, “I don’t handle orthopedic conditions. Our Doctor Lu Cheng is the one in our department who specializes in orthopedic conditions. When it comes to treating joint dislocations, he’s much more experienced than I am.”
“You two wait outside for a moment. Doctor Lu and I will carefully discuss your diagnosis and treatment, and we’ll come back to tell you the results later.”
The girl was taken aback upon hearing this and looked a little scared. “Director Lin? Is this very troublesome for me?”
Lin Qianlong replied, “It’s not necessarily troublesome, it just depends on whether we can handle it.”
“We’ll discuss it carefully.”
The girl and the man left the room with a sense of helplessness, their expressions each showing a hint of conflict.
…
After the patients left the room, Lu Cheng explained carefully to Lin Qianlong, “Director Lin, the shoulder apprehension test （ indicates a tendency towards anterior shoulder dislocation.”
“If the symptoms are relieved during the relocation test, it can be definitively diagnosed as an anterior shoulder dislocation.”
“The release test involves releasing the force from the relocation test. If the shoulder symptoms reappear, it’s a double-insured confirmation… This is a diagnostic trick for anterior shoulder dislocation in the absence of X-ray examination.”
Speaking of which, Lu Cheng continued, “A flattened shoulder deformity, abduction, limited range of motion, and pain are indicative of suspected shoulder dislocation. Palpating the humerus below the coracoid process confirms the diagnosis as subcoracoid dislocation, a type of anterior shoulder dislocation.”
“The three major tests are key physical signs for confirming anterior shoulder dislocation. Palpating the acromioclavicular joint and the joint capsule position helps determine the injury grading.”
“Grading guides treatment. If written in detail, even if we can’t reduce it, it’s an issue of skill, not diagnosis!” Lu Cheng replied with extreme meticulousness.
“Plain films can preliminarily rule out associated fractures.”
“If there are occult fractures, they are not something that can be identified from plain films.”
Although he didn’t know why Lin Qianlong had come, Lu Cheng explained his actions to Lin Qianlong to the best of his professional ability.
Hearing Lu Cheng’s words, Lin Qianlong’s scalp began to tingle slightly.
Lu Cheng is a professional surgeon; this can be confirmed by his very solid basic surgical skills.
But what is the typical diagnostic approach in surgery? Simple and direct: look at the images. If it’s there, it’s there; if not, cut…
However, how did Lu Cheng approach it?
He started by suspecting based on signs, then classified the condition, and after classification, looked for specific signs for repeated confirmation, and then graded it.
This is what all medical departments should do, but ninety-five percent of surgeons do not do it so meticulously and cautiously.
One can see the whole by observing a part.
“Xiao Lu, so, are you saying that you can handle not only tendons but also joint dislocations?” Lin Qianlong stroked his short chin, his small eyes narrowing into slits.
The way Lu Cheng explained his theory, both in terms of depth and structure, had a bit of a formal, academic flavor.
Perhaps Lu Cheng was just ‘average’ in his previous internship and training hospitals, but this is a county hospital, and a remote one at that!
One cannot generalize.
Lu Cheng said seriously, “Director Lin, I wouldn’t say I ‘can handle’ everything, but if I encounter a suitable diagnosis and classification, I will treat it if I can.”
“I didn’t have much experience before, so I could only put in the hard work.”
Lu Cheng had a general understanding of these knowledge points before he joined, and he had independently seen patients with joint dislocations before. However, it was certainly not as detailed, in-depth, or professional as it is now.
This truly is hard work. If he had experience, it wouldn’t be this convoluted; a glance would be enough to determine the situation and how to treat it.
Of course, while the effort is laborious… it is indeed effective and can minimize the risk of misdiagnosis for patients to the greatest extent!
“Then let’s do it! If orthopedics doesn’t handle it, we will!” Lin Qianlong’s mouth curved into a playful smile.
