Radiology Review

Landscaper Can't Outrun Tree

Author and Disclosure Information


A 24-year-old man who works as a landscaper/tree-cutter presents for evaluation of right shoulder pain after a tree fell on him. He states that he attempted to run away as the tree fell, but it struck him nonetheless. He did not lose consciousness. The tree struck the right side of his body. The patient’s medical history is unremarkable. He is complaining of right-side back and shoulder pain. Initial vital signs and primary survey appear to be normal. Secondary survey shows decreased range of motion in the right shoulder, with point tenderness in the scapula. There are no obvious deformities. Distal pulses are strong, and the patient is otherwise neurovascularly intact. Radiograph of the right shoulder is shown. What is your impression?


 

References

ANSWER
The radiograph shows an osseous fragment along the inferior aspect of the glenohumeral joint. Close examination reveals a defect within the scapula itself, most likely consistent with an acute fracture.

Recommended Reading

Grand Rounds: Man, 72, With Peeling Penile Skin
Clinician Reviews
Grand Rounds: Woman, 30, Survives Near-Exsanguination
Clinician Reviews
Grand Rounds: Woman, 80, With Hallucinations and Tremors
Clinician Reviews
Grand Rounds: Five-Day-Old Infant With Hip "Clunk"
Clinician Reviews
Grand Rounds: Girl, 6, With Rapid Heart Rate
Clinician Reviews
Grand Rounds: Man, 65, With Delayed Pain After Hand Injury
Clinician Reviews
Grand Rounds: Woman, 39, With Leg Weakness After Exercise Class
Clinician Reviews
Infant "Fell Out of Car Seat"
Clinician Reviews
Postoperative Patient Experiencing Respiratory Distress
Clinician Reviews
Woman Thrown From Horse
Clinician Reviews