The patient was a very fit , very healthy 28 year old , self employed electrical engineer...
...he told me that his hobbies were swimming and SCUBA diving...
...and that he swam at least 8 miles a week...
...and that he was going on a 2 week diving holiday the following week.
He had been shopping earlier in the day and when he reached up to to get some suntan lotion from a high shelf, he felt something in his right shoulder go "click" and he was convinced that he had spontaneously dislocated his shoulder...
...and that it was still dislocated despite having finished his shopping , been to the pub for lunch, and then driven 5 miles to the Unit .
Now look...you can spontaneously dislocate your shoulder...but mostly its due to direct trauma or a chronic condition in young men who play rugby...
...its virtually impossible to do so de novo shopping in Tescos...
Still...my car doesn't clean itself and so I need to see 30 patients a day so support my otherwise miserable existence, so I was happy to see him.
When he removed his shirt he had a frankly Greek-God-like well-defined upper body musculature...in fact I thought that I was going to have to get a court order to get rid of Julian...who kept on "popping into" my room to offer his help.
Not only did he have complete and full range-of-movement through his shoulder with absolutely no pain whatsoever...
...but his shoulder wasn't red or warm or swollen or bruised...
...he had no distal neuro-vascular deficit of any sort...
...he had what can only be described as a 'normal shoulder', perhaps with a mild tendonitis from carrying his rucksack over his shoulder...
"Oaky sir....well...you have a mild tendonitis...ice your shoulder for a few days...carry your SCUBA tanks over your left shoulder and it will settle down..."
Are you sure....its just that I've paid a lot of money for this trip...and its in the middle of the Indian Ocean...and you know what foreigners are like...
"Yes sir....I know what foreigners are like...I'm consulting with one now..."
Oh...well...I'm just worried that this is going to ruin my holiday...are you sure I haven't dislocated my shoulder...?
"Jah...."
Can't I get an x-ray....?
"No...."
Why not...?
"Because clinically you don't need one...and whilst in principle I am happy to expose large tracts of the general population to unnecessary radiation to at least weed out the crazies, I have no desire to lose my licence."
Oh...well are you sure that you've done all the tests that you can do...?
"Well...there is an old South African Navy test I can do....I don't do it often because the patient needs to be really fit..."
I'm really fit...he interrupted.
"...and its quite painful but it is based on wearing an aqualung...its actually called the aqualung test...would you like me to administer it?"
Yes...please...were you in the navy then?
"Well I was a medic attached to an elite South African Navy Unit called the "WARTHOG's..."
The Warthogs?
"Jah...they were like the American 'SEALs'..."
Oh...what does 'Warthog' mean then...?
"Well its an acronym for 'Water or Air Reconnaissance Team,Headquarters Operational Group'..."
Oh...
"Jah...I went on Operation Mufasa with them..."
He looked at me with new respect ....
Were you a commando then?
"No.....I was just an attached medic..."
He looked suddenly less impressed.
"Okay sir...just please stand up...face me...now pretend that you are wearing a SCUBA tank and what I am going to do is to get you to check the various components...okay?"
Okay...
"So....reach up behind your head as if you were turning on the oxygen valve at the top of the tanks..."
He was able to do that.
"Now place your hand over your left nipple as if you were checking the regulator...'
He was able to do that.
"Now place your hand over your right nipple as if you were checking your compass...'
He was able to do that.
"Now place your hand in the small of your back as if you were adjusting your weight belt...'
He was able to do that.
"Now I want you to do all of those movements as quickly as you can...several times...quite forcefully..."
He nodded his agreement...even Julian (who had snuck back in) was amazed.
"So....slap the pretend oxygen valve...then slap the pretend regulator...then slap the pretend compass...then slap the pretend weight belt...okay...and 'go!' "
Valve-slap/regulator-slap/compass-slap/weight belt-slap
Head-slap/left nipple-slap/right nipple-slap/buttocks-slap
Head-slap/left nipple-slap/right nipple-slap/buttocks-slap
Head-slap/left nipple-slap/right nipple-slap/buttocks-slap
I started to feel sorry for him...
...I knew I was feeling sorry because I was starting to hum, 'In the `navy'.
"Okay...you can stop now...how does your shoulder feel?"
It feels fine..stiff...but that was a really good test...it felt like every part of my shoulder was moving properly...
"Good..."
He started to put his shirt on...
...did you have a good time with the commandos?
"Jah...I had a good time with them....they had a unique motto...."
What was it...?
"It was ...'Draft beer , not people'..."
PS Tishie...tell your friend...apart from the motto...its all true
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