"Brother Lu, is Dr. Tian from orthopedics still not coming? Tayama said that Tian Hongjian is on emergency duty today. Joint dislocation falls under Dr. Tian Hongjian's responsibility."

Tian Zhuang's forehead was tightly knitted with wrinkles, making his already unattractive features look even more troubled.

Lu Cheng listened to Tian Zhuang's words and took a deep breath.

Thinking that Professor Chen Song and Professor Tong Yuan'an had returned home for a brief visit during the Qixi Festival, the orthopedic team immediately reverted to their usual selves. He then looked at his own panel, his expression growing increasingly grave—

[Overall Level: Attending Physician.]

In the real world, he is an attending physician, and even though the panel previously showed he didn't have the strength of an 'attending physician,' outsiders still treated him as one.

And after filling in the gaps during this period, Lu Cheng finally brought his attending physician strength up to par—

[Basic Theory: Surgery (skilled 10/10) (Skill Points -1), Orthopedics (skilled 10/10) (Skill Points -2), General Surgery (skilled 10/10) (Skill Points -1), Basic Theory of Trauma Surgery (skilled 10/10) (Skill Points -1), Emergency Medicine (skilled 10/10) (skilled 10/10) (Skill Points -2)…]

In terms of theory, Lu Cheng improved partially through reading books, with the remainder achieved through skill points to increase skill level to (skilled 10/10).

[Surgical Basic Skills: X-ray Film Reading Skill (skilled 9/10) (+1), CT Film Reading Skill (skilled 9/10) (+1), Magnetic Resonance Imaging Reading Skill (skilled 9/10), Surgical Instrument Operation Experience (skilled 9/10) (+1), Physical Examination Skill (Specialization 2/20) (+1), Auxiliary Examination Reading Skills (skilled 10/10) (+1)]

All basic surgical skills were naturally improved.

[Surgical Basic Operations: Incision Skill (skilled 10/10), Wound Cleaning Skill (skilled 10/10) (Skill Points -1), Suturing Skill (Specialization 14/20), Knotting Skill (skilled 10/10) (Skill Points -1), Puncture Skill (skilled 10/10) (Skill Points -2), Hemostasis Technique (skilled 10/10) (Skill Points -2).]

For basic surgical operations, Lu Cheng used a small number of skill points to bring most abilities up to (skilled 10/10) for practical usage. Without using them, even high-level skills would be wasted.

However, in addition to the general surgery operations, the proficiency in orthopedic surgeries had not seen any progress for a long time, staying the same as before, just not decreasing.

[Surgical Basic Techniques: Open Fracture External Fixation Surgery (skilled 1/10), Fracture Manipulation and Reduction Skill (skilled 2/10), Fracture Open Reduction Internal Fixation Surgery (skilled 0/10), Joint Dislocation Manipulation Reduction Technique (skilled 1/10)…]

[Current Skill Point Balance: 43.3 points!]

Daily skill point yields are only six points. After spending some on Spleen Preservation Surgery and Gallbladder Preservation Surgery, Lu Cheng barely managed to save up 31 skill points, intending to enhance fundamentals and theory for competing to earn money.

But now, upon reflection, reality would not give him the opportunity to save skill points for competition.

"Brother Zhuang... let me handle it." Lu Cheng responded, and with a thought, the skill points began to deplete rapidly.

[Orthopedics (Specialization 0/20) (Skill Points -10), Basic Theory of Trauma Surgery (Specialization 0/20) (Skill Points -10), Joint Dislocation Manipulation Reduction Technique (Specialization 4/20) (Skill Points -23)]

After the sudden allocation of points, Lu Cheng felt a surge of coolness and warmth rising; the coolness entered his brain, and the warmth returned to his hands, bringing a moment of comfort before disappearing without a trace.

Tian Zhuang replied candidly, "Oh, right, Brother Lu, you were also an orthopedic doctor, so you can definitely do it."

Lu Cheng glanced at Tian Zhuang, not explaining much.

Previously, when he was on duty, it was under the banner of orthopedics, and if there were patients he couldn't handle, he could call a superior.

But now, being on duty means he can only call Lin Qianlong for help, and Lin Qianlong coming over would just be for a look without solving much.

The patient's two companions soon returned after imaging, appearing young, possibly around twenty-four or twenty-five years old.

The girl wore a white long dress with a strap, holding her left hand with her right, her slender frame revealing a very noticeable deformity on the left shoulder.

She was clearly angry, with a stern expression on her pretty face, while the man softly apologized alongside her. After returning to the consultation room, the man said, "Doctor, the imaging department said we can only get the films two hours later."

"My wife is in severe pain. Can you think of any way to help?"

The girl's expression flickered slightly at the mention of "wife," but she didn't refute it. She just looked tensely at Lu Cheng and Tian Zhuang, her face tight with pain.

Lu Cheng responded, "Getting the physical printout of the films takes time, but once the imaging is done, we can see the results on the computer."

"However, we need to conduct a physical examination first before looking at the films to make a comprehensive diagnosis."

"Give Dr. Tian the last six digits of your wife's ID number so he can pull up the films first."

While speaking, Lu Cheng approached the girl and said with utmost seriousness, "Stand still; the shoulder examination doesn't require lying down. I'm going to conduct a detailed physical examination on you."

The man, being attentive, gave the number, and Lu Cheng soon found the films, then turned to look at the man and his girlfriend, with concern showing in his eyes.

"Don't be nervous. Try moving your left hand yourself," Lu Cheng instructed.

For a patient with a closed shoulder injury, the primary concern is a fracture, followed by joint dislocation, and finally rotator cuff injuries or other sports medicine conditions.

A fracture can be clearly diagnosed through a physical exam. If there is a fracture, there will definitely be signs like longitudinal percussion pain, local deformity, crepitus at the fracture site, and entirely restricted movement.

Lu Cheng didn't immediately check the site because if the patient can perform self-movement, active movement exists, and 'major fractures' can basically be ruled out!

It's important to know that Lu Cheng's physical examination skill was initially the most proficient and widely utilized, reaching a 'specialization' level!

Fracture patients are unlikely to perform much normal movement, not at all.

"Ouch, it's not possible!~" The girl attempted to lift her left hand, but her face turned pale upon reaching only thirty degrees.

"It hurts a lot... I can't move it!"

Hearing this, Lu Cheng supported her injured arm by the wrist and said, "Alright, if you can't move it, don't. Next, I'll perform some passive examinations on you. Just relax and cooperate..."

If the movement is limited but there is a range, fractures can be ruled out without imaging. 𝕗𝐫𝚎𝗲𝘄𝐞𝕓𝐧𝕠𝘃𝕖𝐥.𝐜𝚘𝚖

Diagnosing a patient is like investigating a case; for beginners, it's like solving a mystery, searching for clues step by step without overlooking any detail...

There are specialized examination techniques in orthopedics and a recommended sequence known as sight-touch-movement-measure.

But the examination order shouldn't be too rigid; adaptation is necessary.

From the moment the girl entered, Lu Cheng had already completed the visual inspection, noting the presence of the "square shoulder deformity" typical of shoulder dislocations!

The most likely consideration was shoulder joint dislocation.

Yet, having experienced Han City University Affiliated Zhongnan Hospital, Lu Cheng had heard from professors about many pitfalls and the caution against allowing the most obvious sign to obscure key diagnoses when assessing patients.

If dislocation is accompanied by a fracture, failing to diagnose it wouldn't merely cause the patient pain; they could accuse you of lacking professionalism!

...

Lu Cheng carefully operated for nearly four minutes before releasing the patient's arm: "Alright, thank you for your cooperation. My examination is complete. Based on the results, it is preliminarily considered an anterior shoulder dislocation."

"It's a simple dislocation, subcoracoid dislocation, with a low grade, likely manageable with manipulation reduction."

"However, the specifics will still be determined after reviewing the films. The examination contents are only for speculation; the films will provide more insight, allowing for accurate diagnosis and treatment selection," Lu Cheng said with a steady, confident voice.