Great doctor starts with adding points

"The lateral epicondyle of the humerus is the starting point of the extensor wrist muscles of the forearm. From top to bottom, there are mainly brachioradialis, extensor carpi radialis longus, and extensor carpi radialis brevis originating from the front and outside of the lateral epicondyle of the humerus."

"Other extensor digitorum, extensor carpi ulnaris, and brachialis originate posterolaterally to the lateral epicondyle of the humerus."

"According to this anatomy, think again, which muscle is the most painful part of her pulling?" Long Yuan chewed up the knowledge point and began to feed.

This is the benefit of academic teaching in teaching hospitals.

People without basic skills will have a blurred expression when they hear it, but Wu Xie's anatomy is at the proficiency level, so Long Yuan just pushed it a little, and Wu Xie immediately reacted.

At the same time, he also saw that the panel flickered immediately: "Get fundamental guidance, knowledge point +1!"

"Digital extensors, carpi ulnaris extensors, and brachialis muscles! Because grandma's lateral epicondylitis is mainly concentrated behind the lateral epicondyle." Wu Xie thought of it and went for a physical examination.

"Grandma Zhang, stretch out your fingers, and the wrist joint won't move!" Wu Xie immediately pinched her wrist joint, and then demonstrated to Mrs. Zhang.

The finger extensors control the extension of the fingers. If it refers to the reaction caused by the pain of the extensors, and the wrist extensors are not moving, then it can be determined that such a physical examination is correct.

Wu Xie's physical examination has also been improved to proficiency, and he can still handle such details.

Granny Zhang followed Wu Xie's example, gasping for breath while moving, and then looked at Wu Xie: "Doctor Wu, will this hurt?"

"Okay, okay, if you don't move, don't move if it hurts. Grandma Zhang, can you try to turn your little finger and ring finger to the outside to stretch your wrist joint?"

"Yes, it's just like this!" Wu Xie continued to experiment.

This is a physical examination of a single muscle to examine the relative specificity of contraction of the extensor carpi ulnaris, its effect on pain.

Seeing this, Long Yuan's eyes were bright, and he looked at Wu Xie with great relief, feeling that Wu Xie had a strong understanding.

The old lady Zhang turned over twice, and it hurt even more, and she looked at Wu Xie with a wry smile: "Doctor Wu, don't play tricks on me, the movements you call me to do are the most painful, you must have thought of it What's the problem?"

Don't think about it, Wu Xie was able to make her do two movements so accurately, one pain in one movement, it must be very clear, compared to other people in the county who watched the film and told her to take medicine and exercise, that's better too much.

Wu Xie nodded and said with a smile: "Grandma Zhang, let's not move. I know you are in pain. We are also doing a pre-diagnosis physical examination. We want to make your condition clearer and clearer."

Mrs. Zhang's daughter saw Wu Xie's miraculousness, and said, "As expected of an expert from Tongji Hospital, I can understand it now. When we were in the county hospital, we didn't do this before. We just shouted outside. Turn it around, don't do it if it hurts."

With a smile on his face, he was full of admiration.

But obviously, her admiration was not what Long Yuan wanted, so Long Yuan continued to explain: "Reading the plain film, reading the report is a state, and seeing the location and nature of the disease is a state, which means you understand .”

"It's a certain level to be able to see some details and the reaction in it. Isn't it?"

"You see, lateral epicondylitis of the humerus, the diagnosis report is one thing. You can understand that there is inflammation here, which is a deep layer, and then you can see that there is bone hyperplasia, periosteal reaction, and sclerosis, which is another deep layer. .”

"Then if we go deeper, we will look at the layers, and the lateral epicondyle is also divided into front, back, inside, and outside!"

"The anterolateral and posterior muscles of lateral epicondylitis have different starting points, so the pain target is different, right?" Long Yuan explained in detail that it requires skill, and Long Yuan has this skill of.

What Long Yuan is complaining about is the details of the level of proficiency in film reading, which requires Wu Xie to study and experience carefully.

"Get fundamental guidance, knowledge point +1!"

On the panel, it jumped again.

Longyuan's strength is definitely not as good as Xiong Yao's, but his teaching level is higher than Xiong Yao's! Perhaps it is easier to teach in clinical medicine.

"Yes, senior brother, I didn't think about it that much before." While Wu Xie was overjoyed, he saw that after receiving fundamental guidance, not only did the knowledge points increase, but even the upper limit of the upgrade was constantly decreasing.

This is equivalent to double the income of knowledge points!

wild!

Long Yuan continued: "Then think about it, why did this old lady suffer from lateral epicondylitis? Let's guess?"

Tennis elbow occurs mostly in young and middle-aged people, and professional factors such as athletes and chefs are very closely related!

Wu Xie flickered when he heard the words, and planned to ask, but Long Yuan interrupted when he saw this: "You have to think, don't ask about the medical history, first guess, and then think about the answer."

This really stumped Wu Xie, or in other words, Long Yuan was simply embarrassing others.

In fact, if you just ask, you will understand everything. Instead, you have to meditate here.

However, there are also corresponding factors, that is, there is a lot of activity or stress on the elbow joint.

These activities are common in rural areas.

"Buying vegetables? Cutting vegetables? Farming?" Wu Xie made three guesses, and didn't mention square dancing. Square dancing won't cause special stress on the elbow joint.

Long Yuan didn't make things difficult for Wu Xie anymore: "I guess it's because he hugged the child."

Then he looked at Mrs. Zhang and Mrs. Zhang's daughter.

Mrs. Zhang laughed, very happy, but Mrs. Zhang's daughter's expression froze: "Doctor Long, you mean, my mother is here to take care of my child?"

Mrs. Zhang has no son, but two daughters. This is still the youngest daughter, so she is also happy to bring her grandson.

"To be precise, it should be hugging the child. If there are many children in your family, I'm afraid both hands will have this tennis elbow!" Long Yuan said while gesturing to hug the child.

Mrs. Zhang said with a smile when she heard the words: "No way, my grandson is so skinny? He is one year old this year and only weighs 30 catties."

Longyuan heard the words and replied: "A normal child only weighs more than 20 pounds at one year old. Do you still think he is thin? You have to control the child's diet. The fatter the baby, the better."

Long Yuan said so, and signaled Wu Xie to start writing the medical records, and then he told Mrs. Zhang some precautions and exercise methods. There is no need to take special medicine, but the only thing is to stop holding children. And the action of chopping vegetables should be done less, and you can cut with light force.

After returning home, I mainly do muscle exercises near the elbow joint, and then I can do some relatively light anaerobic activities. In this way, combined with externally applied pain-relieving ointment, the symptoms can be relieved in the near future.

Mrs. Zhang has the ointment for external application at home, so she doesn’t need to use medicine. She just prescribed a good prescription for Mrs. Zhang. After returning home, don’t hold the baby for three days. If the pain does not relieve, go for an MRI to see if it is There is no organic damage such as ligaments.

Long Yuan and Wu Xie's explanation process was very detailed, so Mrs. Zhang's daughter immediately nodded and responded: "Okay, Doctor Long, after I go back, I must let my mother pay attention, and don't let her secretly hug her."

Long Yuan shook his head and warned: "The old man likes children, it's okay not to hug them, but not to be teased."

"On the lap, it's fine if you don't stress." Long Yuan also gave a dose of both ways to go out, appearing to be quite experienced.

Mrs. Zhang was happy when she heard the words, and said with a smile: "You see, I don't think it's because of holding the baby, but because of the wrong posture..."

Both of them thanked and went out, Long Yuan said to Wu Xie again: "guessing the cause of the disease is the principle of analyzing the disease, if you can know that when holding a child, the child's gravitational stress usually requires tense muscles to resist, you can I can see it."

"It's like this. Ordinary cooks and tennis players, they are wrist muscles such as the brachioradialis and extensor carpi radialis longus. They contract so violently that they cause local microfractures and subsequent inflammatory reactions. In their Under occupational factors, it is generally these muscles that contract more intense pain trigger points.”

"It's like grabbing a gun, pulling the trigger, and it will cause symptoms. This is to read carefully and understand the principle of the disease. When reading the film slowly, you will be able to understand the principle."

"The report, lesions, anatomy and details, levels, and principles are all interlinked, step by step, and I can only read part of it." Long Yuan told Wu Xie everything he could understand.

"Get fundamental guidance, knowledge point +1!" In an instant, another reminder flashed on Wu Xie's panel.

After a patient reads it, three points of knowledge.

"Senior brother is amazing!" Wu Xie gave a thumbs up, sycophanting exaggeratedly.

But I was thinking about it in my heart, if this is the case, then I have to worry about whether I gain more knowledge points from managing the bed or studying.

However, the fire in Wu Xie's heart has just risen.

The next patient directly extinguished Wu Xie's dream of a patient with three points of knowledge.

This is a patient with lumbar intervertebral disc herniation. After reading the film, Long Yuan said, "I don't know much about your situation. You need to see a specialist in spinal surgery."

"Ah? Isn't this all about orthopedics? I also consulted an orthopedic doctor in the county before?!" The uncle who came in had a particularly bad tone, as if Long Yuan was ignorant.

"Yes, that's because there is no department in the county hospital. We only look at orthopedics. You are in spinal surgery. I haven't studied it. I'm really sorry, sir. You can refund the registration fee."

"I can't help but look at it, and then deal with you, right?"

"Look at it if you don't like it. Isn't this a waste of your time and money? It's not easy to do such a thing." Long Yuan's tone was extremely humble.

"Oh, what you said is right, but I'm in trouble. I thought the lumbar disease was not good in this county. Doctor Long, can you help me!" Long Yuan's explanation was so appropriate, this The uncle is not in trouble.

So he went out again with the number on the hang, Wu Xie caught up: "Biao Gonggong, I'm sorry, you need to find a more professional person to look at this."

"Uncles and aunts queuing outside, grandparents, we only look at orthopedics here. If it's spinal surgery or neurosurgery, you don't have to wait in line! I'm sorry!" Wu Xie yelled at the door.

Specialist treatment, only more professional, can be more appropriate diagnosis and treatment.

With such a voice, many people were yelled at, and the person who registered had explained it before, and now he is also taking the initiative to stand up to help refund the fee and give an explanation.

Then Wu Xie introduced the next patient into the consulting room. This patient looked like a specialist in orthopedics.