Chapter 123
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Translator: Ace
Chapter: 123
Chapter Title: The Artist's Torn Rotator Cuff
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"So, when did your shoulder start hurting, and how exactly does it feel?"
While Grandma Heo Sun-nam connected the call, I asked Seong Myeong-in.
"Ah, it's been about two months. As for how... I'm not sure how to describe it. I haven't heard the details from the doctor myself."
"Have you had any other tests or treatments?"
"Ah, yes. I think the first Korean medicine clinic called it frozen shoulder, but later an MRI showed a rotator cuff tear, or something like that."
"I see. Neither one is something that heals quickly."
Even though he wasn't the patient or a guardian, Seong Myeong-in knew quite a bit about it.
Frozen shoulder and rotator cuff tear.
They're completely different conditions, but they share the symptom of not being able to lift the arm, which leads to frequent misdiagnoses.
Since he later got an MRI confirming the rotator cuff tear, the initial Korean medicine clinic probably got it wrong.
The rotator cuff refers to the four muscles that help lift the shoulder.
A rotator cuff tear means those muscles and tendons are ripped and frayed. Naturally, there's no strength left to support and lift the arm on its own.
But what if someone else lifts that arm for them?
It might hurt, but there's no reason it wouldn't go up.
Frozen shoulder is different.
This condition, also called frozen shoulder or adhesive capsulitis, literally means the joint capsule has stiffened and fused in place. Even if a doctor from the side tries to lift the arm, it won't budge.
Of course, this diagnostic method isn't 100% accurate.
Even frozen shoulder patients can have their arms forced up before it gets too stiff, and rotator cuff tear patients might complain so much about the pain that an accurate diagnosis is impossible.
Heck, sometimes misdiagnoses happen even after seeing an ultrasound.
"Yes... She's had physical therapy and keeps getting acupuncture at the Korean medicine clinic, but it's not improving at all, so she's really worried."
"Clinic director~ Should I tell Writer Cheon to come on over?"
While I was talking with Seong Myeong-in, Grandma Heo Sun-nam had successfully persuaded Writer Cheon Won-il.
Persuaded... yeah, that works? It was more like bullying.
"No. For a rotator cuff tear, moxibustion needles would be better. If it's okay, how about we meet at the Seongsu Clinic Seoul Songpa branch a bit later?"
I had regular acupuncture needles on hand, but I didn't carry everything like herbal injections, electroacupuncture, or moxibustion needles.
Of course, consistent treatment with regular needles would help, but since there'd been no improvement in two months, I wanted to try a more aggressive approach.
"Ah, what's all this about bothering you! Our director said it's no trouble at all!"
Perhaps worried about troubling me over the phone, Grandma Heo Sun-nam's shout echoed through the meeting room.
"He's coming?"
"Yep~! Says it's close and convenient."
"I was planning to head there after work anyway, but he's apologizing so much it's making me feel bad. You're not coming just because you feel forced, right?"
"Absolutely not. She's been curious ever since hearing how you treated Director Heo's spinal stenosis."
"This guy's always overly polite, so don't mind it~."
Well, if that's the case, then fine.
I wrapped up the conversation and stepped back for a moment.
It was time for Seong Myeong-in to explain the paintings to the No. 4 branch couple.
"You have an excellent eye! That dragon painting is inspired by Hae dong Yonggungsa Temple..."
"Ooooh!"
He wasn't confident talking about his master's condition, but when it came to his own work, he was ready to talk all night.
The No. 4 branch couple chimed in with "That's so cool!" at every comment from Seong Myeong-in.
But isn't Yonggungsa Temple the one in Busan?
Is it okay to use that as a symbol for the Heavenly Demon?
"Interpretations are up to the viewer, so no issue at all."
Right, this too... if the artist and the owner both like it, then it's good, yeah.
"If you like the dragon, there's this one too. Nangong Family is known for blue as their image color, right? It's not mine, but this artist paints a lot of skies."
Seong Myeong-in showed not just his own works on the tablet but also paintings from other Eastern ink artists.
"Wow, this one and that one would fit the vibe too."
Maybe because Seong Myeong-in and his connections were up-and-coming artists, the prices weren't too high.
That seemed to sway the couple even more. They bobbed their shoulders excitedly at every painting.
"I must've wandered all this time just to meet these paintings..."
Glad they like them, but is it okay to buy that many?
They picked one large piece for each consultation room and a few smaller ones for the hallways.
"You should get one too, director. I recommend this one."
In the midst of it, Grandma Heo Sun-nam pointed out a small dragon painting.
"Writer Seong isn't famous yet, but in 20 years, he'll live up to his name as a great master. I guarantee he'll surpass his master."
...Didn't they say Cheon Won-il's paintings go for tens of millions?
Hmm, hmm!
Not exactly an investment! I was planning to buy one or two anyway!
I should hang one in the clinic too.
I picked the blue rat painting—said to be drawn by Grandma Heo Sun-nam's son—along with Seong Myeong-in's small dragon.
'She likes dragons, huh.'
But somehow, unlike the big dragon the couple bought, this one looked like a snake.
An imugi?
Holding it with the blue rat, it oddly reminded me of the spirit creatures I'd seen on the back mountain.
After finishing up with the paintings, we moved to the No. 3 branch.
"Aigoo, director~ My shoulder's killing me again, so I came by~."
"Oh dear~ You must be suffering. Hard work like yours needs proper treatment. I'll loosen it up good today. Even if you're busy, make time twice a week~."
In the old days, telling him to come twice a week would've gotten a "What, through my nose?!" in anger.
Seeing Kim Chunsik smile brightly brought a wave of emotion.
"Your friendly responses have gotten really smooth now."
"Haha, thanks to you, right? Financial therapy reborn me."
Kim Chunsik grinned.
...Did I corrupt a man who was purely dedicated to treatment?
No, no. Making him come twice a week politely is better for the patients anyway. Good thing overall.
"I was just going to say hi and go, but I ended up with a patient. Thanks for letting me use the facilities so readily."
"Psh, it's not like they'll wear out. Use it as much as you want. What size moxibustion needles? I'll have them prep."
"Depends on the patient's condition."
Just as I finished greeting Kim Chunsik, Cheon Won-il arrived at the clinic.
"Doctor! Over here."
"Myeong-in, why'd you bring up something unnecessary and bother the doctors?"
Unlike Seong Myeong-in, Cheon Won-il matched his image perfectly as an Eastern ink painter.
He had ambiguous hair and beard length, wearing a modernized hanbok.
Grandma Heo Sun-nam, who had forced him to come, had business at the gallery and didn't accompany him, so poor Seong Myeong-in got an earful from his master.
"Director Heo called me, but I'm so sorry to bother you on your day off."
"No need for that. I asked because I wanted to see you soon. Sorry for dragging you out while you're resting."
These polite exchanges could go on forever.
I quickly exchanged a few words with Cheon Won-il and immediately checked her shoulder range of motion.
"I heard your shoulder's been bad from Writer Seong. First, can you try lifting your arm forward?"
Hmm, flexion at 100 degrees.
"Now to the side."
Abduction at 90 degrees.
This was the limit of her active range of motion, lifting the arm herself.
"I'll lift it now. Relax completely."
Next, passive range of motion.
As expected, when I lifted her arm, it went all the way up without issue.
"Ugh."
"Does it hurt?"
"A little."
It hurt, but there was no frozen joint capsule feel like in frozen shoulder.
Probably pain from brushing the torn rotator cuff.
"Make a fist with your thumb tucked under, and spread your arms."
"Ah, yes."
"I'll push, so hold it."
I also did the Empty Can Test as a supplement.
To confirm if it was indeed a rotator cuff issue, especially damage to the supraspinatus muscle.
Tap.
As expected, Cheon Won-il's right arm couldn't resist the downward pressure at all and dropped.
"You probably heard from the MRI, but among the four muscles for lifting the shoulder, it's the supraspinatus that's the problem. The long muscle here, above the shoulder blade."
When I mentioned supraspinatus, Cheon Won-il lightly clapped.
"Ah, right. It was the supraspinatus. Slightly torn, but not severe, so avoid using the shoulder and do physical therapy. If no improvement after six months of conservative treatment, consider surgery. But it's been over two months with zero progress, so it was tricky."
It matched what Seong Myeong-in had told me earlier.
Except for one thing that bugged me.
"Slightly torn?"
"Yes, the MRI showed damage about the size of a fingernail."
Fingernail-sized?
For a partial tear under 1cm, watching with physical therapy is appropriate.
But...
'No? It's torn bigger.'
When I palpated the shoulder and subtly sent qi through my hand, the damage was definitely over 1cm. Probably over 2cm.
I furrowed my brow slightly.
How to break this to her?
"Let's check with ultrasound too."
Rotator cuff tears can be seen on ultrasound or MRI, but MRI usually shows them clearer.
Sure enough, scanning Cheon Won-il's shoulder with ultrasound, the tear didn't look that big.
Why? Muscle fibers overlapping? Stuck together? It definitely feels more damaged...
'Ah.'
A good idea hit me.
If it doesn't show well, make it show.
Unlike MRI, which takes 20 minutes in a machine and costs a lot, ultrasound lets you observe changes better right after intervention.
"38mm herbal injection 1cc diluted with 4cc NS (normal saline) for 5cc, please."
"Herbal injection instead of moxibustion?"
Kim Chunsik, having finished his patient, entered the exam room with shining eyes.
"I'll draw it up!"
Before the No. 3 branch staff could get the needle and injection, Jeon Min-ji prepared the dilution and handed it to me.
"I'll do moxibustion too, but using injection for treatment and to see the tear more clearly."
I injected the needle toward the spot where the tear showed on ultrasound.
Then injected the entire diluted volume there.
Normal saline is fine even in larger amounts into muscle. In fact, it's sometimes injected just for therapy to loosen tight muscles and relieve nerve pressure.
"Ugh..."
Feeling the procedure pain, Cheon Won-il squeezed her eyes shut.
"Huh?"
Then Yu Kyung-hoon, watching the ultrasound screen, was startled.
As I injected, the black line of the tear on ultrasound thickened and deepened.
"The muscle was overlapping the torn part, making it look small. Injecting fluid spread it open like this."
"Wow, you can see it like this with an injection?"
"Never seen that before."
Not just Yu Kyung-hoon, but Kim Chunsik was amazed too.
I smiled proudly.
Phew, I'm adapting to modern tech now!
"Over 2cm. Not a small tear."
If I'd said it felt big from qi sensing, no one would've believed me, but showing it like this, Cheon Won-il and everyone watching nodded.
"Is it serious?"
Seong Myeong-in, who had quietly watched the exam, asked worriedly.
I wanted to say no, but it wasn't minor.
I nodded.
"Usually, 3cm tears get surgery recommended right away, and 2-2.5cm often end up there too. Especially if infraspinatus is involved or full-thickness. ...It looks like partial tear just in supraspinatus now."
I pondered the treatment plan.
As severe as it was, regular acupuncture would have limits.
Indeed, two months of treatment showed little progress.
"Continue acupuncture, and do moxibustion three times at two-week intervals. If no improvement in symptoms or ultrasound after, don't wait six months—go for surgery."
"...Understood."
Cheon Won-il nodded.
Knowing why it hadn't improved was relieving, but no patient likes hearing it's serious.
"Don't get discouraged. That's just the standard plan if no improvement. 2cm partial tears? I've treated plenty."
Plenty.
Really plenty.
How many martial artists have I seen swinging swords until their arms fell off or throwing darts?
"Let's do the moxibustion now."
I confidently tore open the moxibustion needles.