Tolerate More Than Pain
Only sort of broken

A 9-year old male soccer goalie presented to the emergency department with a complaint of forearm pain following a fall on outstretched arm during practice. Pain was located in the mid-distal radius, proximal to the wrist. There was minimal pain with wrist flexion and extension. No pain with movement of the elbow. There is significant tenderness to palpation in a small area of the mid-distal radius without any tenderness proximal or distal to this area. No deformity of the forearm noted. Bedside ultrasound (Image 1) of the area of tenderness is shown below.

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October 23, 2024
Only sort of broken
A 9-year old male soccer goalie presented to the emergency department with a complaint of forearm pain following a fall on outstretched arm during practice. Pain was located in the mid-distal radius, proximal to the wrist. There was minimal pain with wrist flexion and extension. No pain with movement of the elbow. There is significant tenderness to palpation in a small area of the mid-distal radius without any tenderness proximal or distal to this area. No deformity of the forearm noted. Bedside ultrasound (Image 1) of the area of tenderness is shown below.
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Only sort of broken
October 16, 2024
The Other Type of Pediatric Knee Pain
A 9-year-old previously healthy male presented to the emergency department with anterior knee pain after kicking a ball at school. Patient was ambulatory at the school and in the ED although limping due to pain. Patient is an avid soccer player and has not had any previous knee injuries or issues related to knee pain. Physical exam showed a normal appearing knee with point tenderness at the inferior pole of the patella and proximal patellar tendon, painful but intact knee extension and painful ambulation with some mild limping. Distal neurovascular exam intact.
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The Other Type of Pediatric Knee Pain
October 09, 2024
Shouldering Too Much of the Load
A 13-year-old male with no PmHx presents with 3 weeks of progressive shoulder pain. No direct trauma or injury was reported, but the patient reports that the pain began after pitching in a game in which he threw more pitches than usual and during which he exceeded his pitch count. Physical examination was remarkable for significant tenderness to palpation on the lateral aspect of the proximal humerus. Intact ROM and strength, no clavicular or acromial tenderness.
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Shouldering Too Much of the Load
October 02, 2024
Arcuate Sign
A 50-year-old female patient presents to the ED with left knee pain after suffering a hyperextension injury to the left knee. She was walking down steps and reports she internally rotated and hyperextended the knee with immediate pain.
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Arcuate Sign
September 28, 2024
Anterior Knee
A 71-year-old female presents with right knee pain after falling and landing directly on her knee. She has swelling over her knee. You obtain an ultrasound image over the area of most concern.
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Anterior Knee
September 25, 2024
Not So Typical Hip Dislocation
A 20-year-old female presents to the ED after MVC with left hip pain. Notably her leg was up on the dash of the car when the accident occurred. Unable to ambulate since the accident and her pain is constant and worse with attempted movement. She notes muscle spasms around her left hip region. She was lying on the stretcher with the affected lower extremity abducted, slightly flexed and externally rotated without obvious shortening. On log roll testing she reported significant pain especially in the anterior groin region.
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Not So Typical Hip Dislocation
September 19, 2024
Time is Tissue
A previously healthy 14-year-old right-handed male presented to the children’s emergency department with acute onset swelling of the left hand. He awoke in the morning with left palmar swelling and purple discoloration. Over a few hours, the patient’s swelling spread to the distal fingertips and proximally to the left distal forearm. He denied any IV drug use, use of steroids, or recent trauma. Upon arrival at the ED, the patient was hemodynamically stable and afebrile, but his left wrist and fingers were in a flexed position and held upright against the gurney at rest (Image 1). The patient had prominent circumferential swelling from his distal forearm to the fingertip with diffuse tenderness to palpation along the volar forearm, wrist, and hand. He was unable to actively extend his left wrist and digits due to pain. With passive wrist and finger extension, he reported excruciating pain.
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Time is Tissue
September 11, 2024
Bent my bars and my wrist
A 32-year-old female presents to the ED for right wrist pain after a crash in a rock garden during a downhill mountain biking race. She has significant pain in her right wrist but denies any other pain or symptoms including numbness or tingling.
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Bent my bars and my wrist
September 04, 2024
Not So Simple Ankle Dislocation - Sub Talar Trauma
A 45-year-old male was involved in a high-speed interstate MVC rollover accident. Left lower extremity with obvious deformity and open injury.
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Not So Simple Ankle Dislocation - Sub Talar Trauma
August 28, 2024
Back it Up - Addressing Low Back Pain
A 58-year-old male presents to the Emergency Department complaining of low back pain, progressively worse over the last few days. He states that he first noticed the pain after work about two weeks ago and seems to be worse with movement. He has tried heating pads and tylenol with little improvement.
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Back it Up - Addressing Low Back Pain
August 24, 2024
Anterior Elbow
A 67-year-old male is complaining of left upper arm swelling after lifting a heavy object. He has noted a deformity to his upper arm. You obtain an ultrasound image over the area of most concern.
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Anterior Elbow
August 21, 2024
Cutting Edge Blade Encounters: A Review on Hand Anatomy
A 56-year-old male patient presented to the ED after sustaining a circular saw injury to his left hand. He is right hand dominant. The saw lacerated the palmar/volar surface from the wrist joint to the proximal phalanx of the thumb. On exam he is able to extend against resistance with his thumb at the IP joint, is able to cross-fingers/abduct fingers against resistance, but is unable to initiate palmar abduction of the thumb as well as flexion of the thumb IP and index DIP (“A-OK sign”). He also reports decreased sensation throughout the thumb.
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Cutting Edge Blade Encounters: A Review on Hand Anatomy
August 14, 2024
Ditch Dislocation
A 46-year-old male fell into a ditch at a height of approximately 6-7 ft per EMS. He presented to the ED with obvious left ankle deformity seen below.
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Ditch Dislocation
July 31, 2024
Snap and Shift: The Hip Avulsion Saga
A 15-year-old male presented to the emergency department with acute left hip pain after playing basketball. The patient experienced a sharp pain in the left anterior hip after making an abrupt twisting movement while trying to take the ball from his opponent and is now unable to bear weight. He denies numbness, tingling, or other traumas, but reports left leg weakness and pain.
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Snap and Shift: The Hip Avulsion Saga
July 27, 2024
Procedure Knee
A 63-year-old male with a history of R total knee replacement is complaining of knee pain, redness, and swelling. His knee started swelling a few days ago and has pain with flexion. You perform an ultrasound and notice a large effusion. To assist with diagnosis, you opt to perform a knee arthrocentesis.
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Procedure Knee
July 24, 2024
Could You Lend Me a Hand?
An 18-year-old presents with R hand pain and swelling after a tackle resulted in him landing on his hand with his full weight during a rugby match. His x-ray is below.
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Could You Lend Me a Hand?
July 17, 2024
Twist and Shout: A Stressed Out Ankle
A 20-year-old female presents with right ankle pain after a ground level mechanical fall. She has tenderness to palpation of her right lateral malleolus with associated swelling. She was unable to ambulate after her fall.
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Twist and Shout: A Stressed Out Ankle
July 10, 2024
Behind the Knee Pain
A 44 year old male with a PMHx of hypertension, presents to the emergency department with a 3 month history of right knee pain and swelling. Patient installs carpet for a living. Pain is worse when kneeling, better with rest. Patient has taken ibuprofen intermittently for symptomatic relief. Patient tried to see his primary care provider but they did not have any openings.
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Behind the Knee Pain
July 03, 2024
Notch Your Average Sign
A 37-year-old female presented to the ED for left knee swelling and pain after a ground level mechanical fall with possible twisting injury. Patient states she was pushed to the ground and struck her left knee on the concrete, feeling immediate pain and swelling.
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Notch Your Average Sign
June 26, 2024
Popeye’s Peril: The Biceps Blowout
A 38 year male with no significant past medical history presents for right elbow pain after a skydiving injury. He states that while he was trying to adjust his chute, a gust of wind caught his chute and his arm was jerked straight and he thinks he heard a pop. He has pain and weakness with opening jars. He denies numbness or tingling. On exam his arm appears like Image 1. He has ecchymosis on the medial aspect of his arm. Motor strength reveals 4 / 5 flexion and 3 /5 supination with pain. When his arm is flexed to 90 and he supinates against resistance, there is no cord-like structure on palpation. Radiographic imaging is normal.
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Popeye’s Peril: The Biceps Blowout
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