sk732 Posted October 15, 2015 Share Posted October 15, 2015 I was on an evening shift yesterday when I pick up this 20 year old complaining of am shoulder pain for 2 days and that "my collar bone is floating". Denies trauma, heavy lifting, side sleeping, arthritis, fevers, chills, sweats, weight changes or joint laxity. General review of systems is negative. He's AVS(N)/NAD; tall, thin dude, some thoracic scoliosis. Relative arachnodactyly, though not as profound as I've seen before. Just eyeballing him, he's got a 2nd Deg AC separation on the ® with impingement in greater than 85Deg abduction. (N)/= power/tone/sensation otherwise, no other joint laxities elicited. (N) lung and heart sounds without murmur. XRay confirmed the AC separation and CXR showed some kypphoscoliosis and that lateral views showed a very narrow chest. Kid didn't have a real family doctor to follow up with, so I took the liberty of sending him to medical genetics to formally rule in/out Marfanism or Ehler-Danlos. Anyone else around here see a spontaneous AC separation before? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 16, 2015 Moderator Share Posted October 16, 2015 nope. weird. my weirdo last night was a 20 ish yr old female cracked off her gourd on molly. she was chewing the wheelchair she was in ands making suckling sounds. wish I could have done a video to show kids... Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 16, 2015 Moderator Share Posted October 16, 2015 heigth to wing span is always nice to document on these ? Marfans Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 16, 2015 Share Posted October 16, 2015 Bet most here are not familiar with E-D and the variants (I wasn't till brought to my attention a couple of years ago). Suspicious for daughter who declines genetic testing for vascular component. Can't say I blame her since no tx.. Some joint hyper mobility though not "double-jointed" or w/ hx of subluxation. Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
sk732 Posted October 16, 2015 Author Share Posted October 16, 2015 I recalled something from school about E-D and have never really given it any consideration until I ran into another patient in the ER a few months back with it, so did some reading. Dude's wingspan here wasn't as bad as I've seen - his finger tips only went to about half way down his thighs. I have seen some literal finger draggers before, where they go to the knees and beyond. Reminds me of a character from John Wyndham's "The Chrysalids", a "mutant" banished to "The Badlands" due to being Marfanoid...he apparently didn't meet the Biblical definition of human. SK Link to comment Share on other sites More sharing options...
Evolute Posted October 18, 2015 Share Posted October 18, 2015 "kid didn't have a real family doctor to follow up with, so I took the liberty of sending him to medical genetics ......" ........ So, given your above statement, where/who are the test results being sent too? Who is following up? You? After all the "kid didn't have a real family doctor". You ordered the tests.... doesn't that make you responsible? Just sayin'. If you are in FM, IM or any other specialty that treats patients on an on going basis, then I get it the results will come to you and you can f/u..... if not... what do you plan to do with the test results when they bounce back? Im not trying to be a pr!k, I'm just thinking from an ED stand point. Link to comment Share on other sites More sharing options...
waky02 Posted October 19, 2015 Share Posted October 19, 2015 The thumb sign is a easy and quick test to help you rule in marfans or marfanoid syndromes Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 19, 2015 Moderator Share Posted October 19, 2015 E-D Emergency folks should know about this one..... AAA is always in the Ddx... http://www.hindawi.com/journals/ijvm/2013/267215/ Link to comment Share on other sites More sharing options...
sk732 Posted October 20, 2015 Author Share Posted October 20, 2015 I doubt I'll get the consult back - as there is no primary care provider, he'll be instructed to get one or any other specialists he gets referred to as a result might pick him up. As for tests - the only ones ordered were the XRays I had done in the ER. Ain't the system grand..? SK Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.