Despite the patient's denial, the physician contacts law enforcement authorities and reports that they are treating a possible gunshot wound. The child tells you that her shoulder hurts and cannot be any more specific. Upon examination, you find considerable bruising in the scapula area of the right shoulder. You find additional bruises and tender areas on the patient's back, buttocks and thighs. The parent indicates that the child falls frequently and plays with children who are sometimes rough.
Radiographs show the scapula to be intact, but there is evidence of healed rib fractures.
Given the extent of the injuries, the provider contacts the Division of Family Services and reports child abuse. Case 3 A patient presents at your office with two black eyes and a contusion across the bridge of the nose. The patient explains that they opened the car door quickly and struck their nose causing the injuries. You notice bruising on the forearms and upper arms and fresh scrapes on the neck. Upon inquiring, the patient reports rough sex and occasional pushing and shoving matches with their spouse.