Great doctor starts with adding points

Luo Wei handed the NMR to Wu Xie, feeling a little apprehensive!

Long Yuan asked Wu Xie to watch the film, maybe there is something he didn't understand?

In fact, Luo Wei has no hatred for academic qualifications, but has seen some masters with high academic qualifications but low skills, but this misunderstanding is not because academic qualifications are worthless!

It should be accurately said that if such a person does not have a higher education, he will be even less valuable. Rather than a master's or doctor's degree, it must be such a person!

However, Luo Wei thought to himself that his current level in the county hospital is comparable to that of an ordinary deputy chief physician, and he is still fine. This MRI, which he has just seen, should not have too many problems, at least the rotator cuff There is no damage to the tendon.

Therefore, even if Wu Xie looked at it again, he shouldn't be able to see any flowers coming, right?

However, because Luo Wei had seen Wu Xie's extremely professional physical examination on the joint examination before, Luo Wei's heart beat again, for fear that he would lose face because he was not as good as Wu Xie.

Wu Xie said to Wang Hai: "Uncle Wang, wait a moment, I will follow the two teachers to see and learn."

Wang Hai only nodded and said yes, he was not in a hurry, everyone had learned without qualifications, and it was not urgent for him, and he could afford to delay.

Wu Xie took over the MRI, and first paid attention to some details, which is the right shoulder joint that Wang Hai mentioned, and then looked for some more important reading positions, such as the continuity of the rotator cuff of the shoulder joint, the acromion, etc. wait.

In fact, there is a certain order in reading films, it just depends on whether you can summarize it yourself.

Probably after qualitatively failing to see the specific interruption of muscle continuity, Wu Xie turned his attention to the anatomy!

As the eyes swept over, the brain was also spinning rapidly, the knowledge of anatomy and MRI reading knowledge was ups and downs, as if Wu Xie was picking a concubine, or glanced over, or twisted up for a closer look!

There is no problem with the continuity of the rotator cuff, no rupture of the shoulder joint capsule, no fracture, no joint dislocation, and no osteoarthritis!

However, when Wu Xie saw the sub-shoulder bursa, he finally found out what was wrong.

The subacromial bursa, one of the largest bursa in the whole body, is located below the acromion, coracoacromial ligament, and deep fascia of the deltoid muscle, and above the rotator cuff and greater tuberosity of the humerus. This position can only be found through anatomical knowledge on the MRI.

It may be difficult for non-professional doctors to know that there are actually two gaps in the acromion.

One is the rotator cuff space, also known as the traditional shoulder space, and the other is the subacromial space.

The rotator cuff space is an anatomically located diaphragm between the anterior inferior of the supraspinatus and the superior of the subscapularis. The medial side is the coracoid process, the lateral side is the lesser tuberosity of the humerus, the superficial layer is the coracoacromial ligament and the coracohumeral ligament, and the deep layer is the brachial biculum. tendon and superior glenohumeral ligament.

The subacromial bursa is located in the subacromial space.

"Thickening and edema of the subacromial bursa, fluid accumulation under the synovium, non-infectious inflammation and edema of the coracoid-acromial ligament." Wu Xie muttered to himself while watching.

Then I searched a few more places and found no other problems, so I said: "Brother, Mr. Luo, it should be subacromial bursitis, right? His subacromial gap is slightly widened. During the physical examination, it should be the shoulder. There are obstacles in the movement of the joints, pain in activities, and pain before going to sleep."

When Wu Xie said this, Wang Hai's eyes lit up instantly: "Doctor Wu, are you really accurate?"

Wu Xie smiled when he heard the words: "Uncle Wang, this is not calculated. These are the conclusions drawn by the seniors, and there are evidences to follow."

Having said that, the diagnosis of Wang Hai is basically clear.

After Luo Wei's eyes flickered for a while, he wrote several diagnoses of subacromial bursitis. Then, when Wu Xie gave Wang Hai a physical examination, the trigger pain of the corresponding subacromial tender point was also Give it a check out!

When the medical history, physical examination, and imaging examinations are all supportive, the diagnosis is clear, and the treatment is correspondingly clear.

Long Yuan said: "Your situation is now clearer. It is subacromial bursitis, which is also called frozen shoulder by Dr. Luo. However, frozen shoulder is slightly different. You need to strengthen functional exercises. , and then cooperate with taking medicine."

"If the symptoms and pain are severe, a shoulder lysis might be the way to go!"

"But I look at your current expression, this situation should be okay, so, I suggest you do more chest expansion exercises, if you really can't stand it, you can come to the hospital to see us, I will give you a manual release, the symptoms It will be relieved accordingly, do you have medicine at home?" Long Yuan asked.

Wang Hai nodded: "There are some, but it doesn't work well after eating."

Long Yuan said: "Then continue to eat first, and when Dr. Wu and I go to your noodle shop for breakfast tomorrow morning, we will teach you some rehabilitation exercises on the spot. It’s easy to demonstrate, do you think it’s okay?”

"Okay, thank you Doctor Long, I'll treat you to breakfast tomorrow!" Wang Hai nodded hurriedly.

Although he didn't know what Long Yuan meant by bursitis, he trusted Long Yuan and Wu Xie very much. After all, in his opinion, Long Yuan and Wu Xie had seen his illness thoroughly. It's like eating and drinking water.

"We'll eat breakfast by ourselves. You can go back and continue working. It's okay. You just need to move more, but you must avoid particularly strenuous activities. Otherwise, you'll have to suffer and suffer for a long time. !” Long Yuan made another joke like this.

Subacromial bursitis may rupture during natural activities, and the pain after rupture is unbearable for ordinary people.

Wang Hai immediately walked out with a smile, looking forward to tomorrow when Wu Xie and Long Yuan can teach him how to recover.

...

After Wang Hai left, neither Wu Xie nor Long Yuan was in a hurry to call the next patient in, but Long Yuan asked, "Xiao Wu, why are you considering subacromial bursitis? What is the cause?"

Long Yuan continued to sharpen Wu Xie's clinical thinking and build a thinking mode.

Wu Xie glanced at Luo Wei upon hearing this.

Luo Wei understood what Wu Xie meant, and said, "Xiao Wu, if you have something to say, just say it, we all learn from each other."

Wu Xie said cautiously: "At present, a relatively popular trend is to give up the diagnosis of frozen shoulder and use specific diagnosis methods such as subacromial bursitis, rotator cuff injury, acromial impingement syndrome, and calcified tendonitis. The diagnosis replaces the general diagnosis of frozen shoulder!"

"In this patient, the rotator cuff gap is good, and the shape of the four rotator cuff muscles is not interrupted. Then, there is no abnormality in the acromion, no obvious inflammation in the biceps tendon and acromioclavicular joint, but the subacromial space is Widened, with edema and thickening of the bursa, and fluid accumulation, the main consideration is subacromial bursitis, also called frozen shoulder!"

When Wu Xie said this, Luo Wei's face turned dark, and then turned a little red.

Well, I thought my level was not bad, but I didn't expect Wu Xie to see more things.

And they are all professional, speaking in professional language, this is the real strength.

High education does not mean low energy!

However, Wu Xie obviously didn't stop, and continued: "For Wang Haibo, the cause of subacromial bursitis should be the overuse of the shoulders. After all, his family runs a noodle restaurant and chops minced meat every day."

"There are no irritating structures such as bone spurs seen in the anatomy, and I consider overuse."

"The reason it's identified as bursitis is because bursitis is usually caused by things like overuse of the shoulder, injury, infection or autoimmune disease. Inflammation causes an increase in fluid in the bursa, which can This increases the pressure in the bursa and stimulates the nerve endings around the bursa, which can cause shoulder pain."

"I asked speculatively if there is pain before falling asleep, is that pain at night may be related to body posture. When sleeping, the body is in different positions, and some positions may cause extra pressure and tension on the shoulders, which in turn can aggravate shoulder pain. pain."

"Additionally, increased circulation during the night as the body relaxes leads to more engorged blood in the inflamed area, which further irritates the nerve endings, leading to nocturnal shoulder pain."

Wu Xie also learned to further explain the reason, which may not be completely correct, even the reasoning process is wrong, but if there is something to say, just say it, and only when there is something wrong can others see it.

Well, when Luo Wei heard Wu Xie babbling so much all at once, his heart sank, and he let it go!

A person may be a little bit better than you, and you will have the desire to catch up with him. If he is much better, then call 666, how simple.

Long Yuan also nodded: "That's right, remember to be more careful next time."

"The biggest cause of subacromial bursitis is the age factor! Don't be limited to books and theoretical knowledge, but learn and use it flexibly. If you are limited, you will really become a nerd."

"In addition, when looking at the MRI, in addition to looking at the inflammation and effusion of the synovium, we must also pay attention to the layers. The subacromial bursa has two parts, the subacromial and the subdeltoid. Although the two bursa are connected, the Patients had more inflammation in the subacromial bursa portion."

"And the synovial bursa under the scapula is also inflamed, but it's not as serious. This is the benefit of looking at the layers. Layer by layer, it can be analyzed."

When Wu Xie heard this, he discovered the New World in an instant.

Knowledge point +1!

Nodding with a smile: "Okay brother!"

Wu Xie and Long Yuan went back and forth this time, and Luo Wei was very uncomfortable being caught in the middle, and said with a smile: "Brother Yuan, you are so strict with Xiao Wu, you have seen him so carefully, why do you still want to talk about him?"

Long Yuan smiled, expressed his attitude and said: "Brother Wei, if you don't talk about it, you won't be able to make progress. If you talk about something, just talk about it. When there is nothing to say, everyone is confused!"

Luo Wei was a little taken aback, remembering that Long Yuan said in front of Lu Junyin that he would talk too much about Zhong Yusheng and Guo Lixiang, so he sighed seriously: "Brother Yuan, it would be great if you were my teacher."

"But it is estimated that my understanding and ability cannot reach the level of your student!"

"Xiao Wu is also amazing! Maybe this is what it looks like to study?"

I am very impressed!

One is that Wu Xie's basic skills are solid! The theory is solid, combined with practice, every point can be analyzed to the fundamental point, and connected with theory.

The second is Longyuan's teaching ability, which gradually deepens layer by layer, and can properly point out your mistakes and what you can learn.

Luo Wei, put down your face and be a student. What kind of old doctor are you now? You can't even keep up with a student's knowledge reserve!

Luo Wei is very grateful to Lin Peiyuan. This decision and action he made is absolutely correct!