After the story about serohepatitis many ask why the pain extends from the diaphragm to the shoulder. I'll tell you another story. Again about the student.
Man sent to me with a diagnosis of myositis. Student looks unhappy. He was pale, with a temperature of 38, sweats and breathes.
It was morning. All night the ambulance drove the student to hospitals. He complained of pain in the neck and fever.
In standby the hospital he found a lot of white blood cell count and decided that somewhere must be pus.
Sore neck examined both the relevant specialist. It so happened that on duty hospital shortly before enlarging, and it appeared simultaneously department of otolaryngology and purulent surgery.
Purulent pus surgeon sought in the neck outside and otolaryngologist - inside. Nothing they did not find, in addition to severe muscle soreness above the collarbone. Surgeons decided that no pus in the area do not. Leukocytosis written off for a late supper and sent a student to me to treat myositis.
And then I look at the student, and he looks bad. Guy pokes himself in the neck. And not just in the neck and between the legs of sternocleidomastoid muscle. It looked like the picture in the textbook.
It called the case frenikus-symptom. Frenikus - phrenic means. Phrenic nerve runs from the diaphragm up somewhere between the legs of sternocleidomastoid muscle. If you turn your head to the side, this muscle will tighten, and it is easy to find.
In cases of serious inflammation in the iris can get sick neck. Inflammation may be a diaphragm or above the diaphragm.
I asked the student, not sick if he had a stomach. He says he is not ill. I said, listen to anyone his back tube. It turned out that was not listening.
That is the guy all night with a fever ridden in an ambulance. He found leukocytosis, picked open neck inside and out, but not listened to the lungs.
What do you think I heard him right under the shoulder blade? Right! Reduced air and crepitus. It was also strengthening the voice tremor. Pneumonia.
And the student went back to the emergency room, but in a therapeutic hospital.
Here's a frenikus-symptom. Maybe someone will come in handy.
