This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 64 The True Attending Physician!
"Brother Lu, is Dr. Tian from the orthopedics department still not coming? Tian Shan said it's Dr. Tian Hongjian's emergency shift today. Joint dislocations are under Dr. Tian Hongjian's jurisdiction."

Tian Zhuang's forehead was covered with wrinkles, and his already unattractive face looked even more troubled now.

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

Knowing that Professor Chen Song and Professor Tong Yuan'an had temporarily returned home for Qixi Festival, the orthopedic team members immediately revealed their true colors, and then looked at their panels, their expressions becoming increasingly solemn—

[Overall Level: Attending Physician]

In the real world, you are an attending physician. Even though your stats didn't show that you were an 'attending physician,' people still treated you as one.

After Lu Cheng's efforts to identify and address any shortcomings, the attending physician's skills finally caught up.

【基础理论：外科学（熟练10/10）（技能点-1）、骨科学（熟练10/10）（技能点-2）、收外科学（熟练10/10）（技能点-1）、创伤外科基础理论（熟练10/10）（技能点-1）、急救医学（熟练10/10）（熟练10/10）（技能点-2）……】

In the theoretical part, Lu Cheng improved by reading books, and the rest he relied on skill points to increase his proficiency (proficiency 10/10).

【外科基础技能：X线阅片术（熟练9/10）（+1）、CT阅片术（熟练9/10）（+1）、核磁阅片术（熟练9/10）、外科器械操作经验（熟练9/10）（+1）、体格检查（专精2/20）（+1）、辅助检查阅读技能（熟练10/10）（+1）】

Basic surgical skills improve naturally.

【外科基础操作：切开术（熟练10/10），清创术（熟练10/10）（技能点-1），缝合术（专精14/20）、打结术（熟练10/10）（技能点-1）、穿刺术（熟练10/10）（技能点-2）、止血术（熟练10/10）（技能点-2）。】

In the basic surgical procedures section, Lu Cheng used a small number of skill points to fill in most of the abilities (proficient 10/10), mainly for the purpose of use. Otherwise, no matter how high the skill level is, it will only be useless.

However, apart from general surgery, the level of skill in orthopedic surgery has remained largely unchanged for a long time, only without any reduction.

【外科基础术式：骨折切开外固定术（熟练1/10）、骨折手法复位术（熟练2/10）、骨折切开复位内固定术（熟练0/10）、关节脱位手法复位术（熟练1/10）……】

[Current skill point balance: 43.3 points!]

Lu Cheng only earns six skill points a day. Because some of them are used to add points to the Spleen Preservation Technique and Gallbladder Preservation Technique, he barely managed to save up 31 skill points. He originally planned to add points to the basic skills and theory to participate in competitions and earn money.

But now that I think about it, reality doesn't give me the chance to accumulate skill points for competitions.

"Brother Zhuang... let me take a look." After Lu Cheng finished speaking, his skill points began to disappear rapidly.

【骨科学（专精0/20）（技能点-10）、创伤外科基础理论（专精0/20）（技能点-10）、关节脱位手法复位术（专精4/20）（技能点-23）】

After the sudden boost, Lu Cheng felt two streams of cool and hot energy rising up, one cool to the spleen and the other hot to the hands. The cool energy entered his brain and the hot energy returned to his hands. After bringing a sense of comfort, it disappeared without a trace as he turned around.

Tian Zhuang replied straightforwardly, "That's right, Brother Lu, you were an orthopedic surgeon before, you can definitely do it."

Lu Cheng glanced at Tian Zhuang but didn't explain much.

He used to be on duty under the name of orthopedics, and if there were patients he couldn't handle, he could ask his superiors for help.

The meaning of being on duty now is different. If I ask my superiors again, I can only ask Lin Qianlong. Even if Lin Qianlong comes, he can only stare blankly.

The two patients returned quickly after completing their scans. They looked quite young, around twenty-four or twenty-five years old.

The girl was wearing a white long dress with spaghetti straps, her right hand holding her left hand. She had a thin figure, and her left shoulder deformity was very obvious.

She was clearly angry; her pretty face was pale and trembling. The man apologized softly. Back in the examination room, he said, "Doctor, they said the X-rays won't be ready for two hours." "My wife is in so much pain, is there anything you can do?"

When the man said the word "wife," the girl's expression flickered slightly, but she didn't argue. She just clung tightly to Lu Cheng and Tian Zhuang, her face contorted with pain.

Lu Cheng replied, "It will take some time to get the physical printouts, but once you finish taking the photos, we can see the results on the computer."

"However, we need to perform a physical examination first and then look at the images to make a comprehensive diagnosis."

"Give the last six digits of your wife's ID number to Dr. Tian and ask him to retrieve the images first."

As Lu Cheng spoke, he walked over to the girl and said very seriously, "You can stand still; you don't need to lie down for the shoulder joint examination! I'm going to give you a thorough examination."

The man was quite attentive; after giving out the number, Lu Cheng found the film. He then turned to look at Lu Cheng and his girlfriend, his eyes filled with worry.

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

For a patient with a closed shoulder injury, the first thing to consider is a fracture, followed by a joint dislocation, and finally sports medicine conditions such as rotator cuff tears.

Whether or not a fracture has occurred can be clearly diagnosed through physical examination. If it is a fracture, there will definitely be signs of a fracture, such as longitudinal percussion pain, local deformity, friction rub at the fracture ends, and complete restriction of movement.

Lu Cheng didn't examine the local area first because if the patient could learn to move on their own, then there was active movement, which basically ruled out a 'large segmental fracture'!
It should be noted that Lu Cheng was originally most proficient in physical examination techniques, which were also the medical procedures he had the most access to, and had long since reached the 'specialist' level!
Patients with fractures cannot have much normal activity, not even a little bit.

"Oh no!~" The girl's face turned deathly pale as soon as she raised her left hand by only thirty degrees.

"It hurts so much... I can't move!"

Upon hearing this, Lu Cheng reached out and held her injured wrist, saying, "Okay, if you can't move it, then don't. I'll give you a few passive physical examinations next. Just relax and cooperate..."

The patient's activity is limited but still within a certain range, and a fracture can be ruled out without reviewing X-rays.

Diagnosing a patient is like solving a crime. For beginners, it's like cracking a case, searching for clues step by step, and no detail can be overlooked...

Orthopedics has a specialized physical examination, and a specific sequence called visual tactile measurement.

However, the order of physical examinations should not be too rigid and should be adapted to the situation.

Lu Cheng actually completed the visual examination the moment the girl entered the room, and the patient had a fairly typical "square shoulder deformity"!
The most likely diagnosis is shoulder dislocation.

Lu Cheng, who had once worked at the Zhongnan Hospital affiliated with Wuhan University, had heard professors talk about many pitfalls, warning him that the most obvious physical signs could obscure other crucial diagnoses when seeking medical treatment.

If a dislocation is accompanied by a fracture, but you fail to diagnose it, it's not just the patient who suffers; they will sue you for being unprofessional!

……

Lu Cheng slowly and meticulously operated for nearly four minutes before lowering the patient's arm: "Okay, thank you for your cooperation. My examination is complete. Based on the results, the preliminary diagnosis is anterior shoulder dislocation."

"It's a simple dislocation, subcoracoid dislocation, and the grade is very low, so it should be treatable with manual reduction."

"However, we will determine the specific situation after reviewing the images. The findings from the physical examination are only for speculation. We can glean more information from the images and then make a diagnosis and choose the appropriate treatment." Lu Cheng's voice was calm and powerful.

(End of this chapter)