Ortho EM Pearls

Tolerate More Than Pain

A Fateful FOOSH

A 66-year-old male with right anterior elbow pain, ecchymosis, and a “lump” in his right upper extremity after a ground level fall.

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October 25, 2025

Shoulder

A 54-year-old female presents with left shoulder pain. She has been having pain with overhead movements. To assist with diagnosis, you opt to perform an ultrasound. You obtain the image below.

October 22, 2025

A Fateful FOOSH

A 66-year-old male with right anterior elbow pain, ecchymosis, and a “lump” in his right upper extremity after a ground level fall.

October 15, 2025

Goodbye Thigh

A 40-year old male presents with left proximal hamstring pain that occurred suddenly during a CrossFit workout. He felt a pop and now has tenderness and ecchymoses over the posterior hip, with reduced strength of knee flexion.

October 01, 2025

It's More Than Shin Splints

A 24-year-old female presents with pain in her lower left leg that has been increasing while training for a marathon. She is point tender on the medial side of her mid-tibia and has pain with ambulation.

September 24, 2025

Walking with Swagger

A 5-year-old male is brought into the emergency department by his father after his father noted that he has been limping for the past few weeks. The patient endorses mild pain in the left hip with no other systemic symptoms. You note decreased internal rotation and abduction of the hip on exam and laboratory workup is unremarkable.

September 17, 2025

Show me your middle finger.. I can’t - it’s numb

A 31-year-old male presents as a trauma after a 15 foot fall off of a ladder, landing on his outstretched right upper extremity. He has significant tenderness over his right wrist and sensation deficits of his right 3rd – 5th digits.

Show me your middle finger.. I can’t - it’s numb

September 03, 2025

Plant and Pop

A 39-year-old male presents with left medial calf pain. While playing dodgeball, he planted his left foot to throw and felt an immediate pop with pain and swelling within hours of the injury.

August 30, 2025

Lateral Knee

A 57-year-old male notes lateral knee pain after playing tennis. You perform an ultrasound and obtain the image below.

August 27, 2025

I Felt a Pop and My Elbow Hurts...

A 13-year-old male presents with acute onset of medial elbow pain after throwing a football, at which time he felt a ‘pop’ and is now unable to fully extend at the elbow. He is tender to palpation at the medial epicondyle. He has a history of Little Leaguer’s Elbow.

August 20, 2025

Pop Goes the Knee

Pop Goes the Knee Author: Tyler Jackson, MD, CAQ-SM Peer-reviewer: Terese Whipple, MD, CAQ-SM Final editor: Alex Tomesch, MD, CAQ-SM A 25-year-old male presents with right knee pain after a bicycle accident in which his knee twisted after planting his foot while falling off the bicycle. He also reports his knee occasionally “locks” when trying to ambulate since the injury. ROM is restricted with knee extension and flexion.

Cite This Article

Image 1 and 2. MRI R Knee (Sagittal and Axial PD) Case courtesy of Dr. Varun Babu, Radiopaedia.org, rID: 56916

What is your diagnosis?

How does this injury present in the ED?

What is your disposition and how soon to follow up?

What are your potential radiographic findings?

References: [1][ Chambers HG, Chambers RC: The natural history of meniscus tears . J Pediatr Orthop. 2019, 39:53-5. [2] Jarraya M, Roemer FW, Englund M, et al.: Meniscus morphology: does tear type matter? A narrative review with focus on relevance for osteoarthritis research. Semin Arthritis Rheum. 2017, 46:552-61. [3] Esparragoza-Montero R, Rodriguez-Diaz J, Lanier- Dominguez J, et al. Evaluation of meniscal morphology and relation between the diagnostic findings of magnetic resonance imaging and arthroscopy in lesions of the knee. Invest Clin 2009;50(1): 35-44.

August 13, 2025

Cartilage or Crack?

A 13-year-old male presents to the urgent care after rolling his left ankle while playing soccer. He now has pain and swelling around the outside of his foot and can’t bear weight on it. X-rays are taken and shown below:

August 06, 2025

What's the Scoop?

A 13-year-old obese female has had a limp for 3.5 weeks. Her x-ray is shown below.

July 30, 2025

Does Your Toe Hurt That Much?

A 22 year old football player limps to the sideline after catching a sideline pass requiring him to land on his toes to complete the catch in bounds. Now he is complaining of pain at his right 1st MTP saying that he thinks his “toe popped out”.

July 26, 2025

Elbow

A 65-year-old male presents with right elbow pain. He noticed sudden pain and swelling while doing a weighted exercise. You perform an ultrasound and obtain the image below. What is your diagnosis?

July 23, 2025

Knee Went Out

32-year-old male was doing a 425 lbs back squat and felt a painful “pop” in his anterior right knee above the kneecap and dropped to the ground. He has been unable to walk and his knee is extremely swollen. X-rays are read as normal but he cannot extend his knee on exam.

July 16, 2025

The Swelling That Would Not Go Away

A 34-year-old male patient presents to the emergency department due to a progressively expanding mass on his left buttock. Two months prior to this visit, the patient had been injured in a motorcycle collision. Computed Tomography (CT) performed on the day of his initial injury showed a non-specific fluid infiltration over the left iliac crest, lower back, and buttock, without a large fluid collection, considered to be hematoma. On his second visit, there was a firm and tender mass measuring approximately 21 x 18 cm with overlying erythema on the left buttock. The patient reported progressive enlargement of this mass over the prior months and sensitivity to light touch. Vital signs were noted to be stable. CT with contrast as well as Magnetic Resonance Imaging (MRI) were performed.

July 09, 2025

Jump, Land, and Tear

A 32-year-old male patient presented to the emergency department due to left knee pain. He was playing basketball when he came down from a vertical jump onto his left leg. He stated his kneecap appeared to be displaced laterally. On examination, patient had decreased range of motion of the left knee, tenderness on palpation of the lateral and medial aspect of the knee, and he was unable to extend his knee.

July 02, 2025

Running on Empty

A 20-year-old female presents to the ED for evaluation of hip pain that has been progressively worsening over the last month. She has been feeling sharp pain in both hips for the last 4 months during daily runs, which have been consistently 8-10 miles. She is now reporting constant pain in her bilateral hips even at rest for the past 2 weeks. Denies any falls or trauma.

June 28, 2025

Wrist

A 45-year-old woman presents to the ED with right wrist pain. She notes she fell forward and landed on an outstretched hand 3 days ago. You decide to ultrasound the area of concern.

June 25, 2025

Don’t Go Breaking My Heart

A 45-year-old male presents to the emergency department with chest pain after a high-speed motor vehicle accident where his chest hit the steering wheel. He is complaining of central chest pain and there is ecchymosis noted over his sternum.

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