Ortho EM Pearls

Tolerate More Than Pain

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.

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September 17, 2025

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 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 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.

June 18, 2025

It’s all Spine

A 38-year-old male presents with acute on chronic low back pain. On arrival, he has a fever, 3+/5 strength of the right leg, and 5/5 strength on the left. Sensation to light touch in his bilateral lower extremities is intact with a positive straight leg test bilaterally.

June 11, 2025

Tri Not to Fall

A 21-year-old male fell off an ATV while riding up a hill. He presents with right wrist pain and no other complaints. Right wrist exam demonstrates mild swelling of the dorsum of the hand and tenderness over the ulnar aspect of the wrist. Neurovascular intact.

June 04, 2025

Kneed to Know

A 17-year-old male with no significant medical history presenting with 3 days of left knee pain after playing soccer at school. He was kicked in the left knee and felt a sudden shift in his knee followed by pain. On extension of his knee, he felt a snapping sensation with improvement to symptoms. He has continued to have worsening pain and redness despite rest. Of note, he had a similar injury years ago and was never evaluated at the time.

May 31, 2025

Lower Leg

A 65-year-old male presents with left calf pain after playing tennis. He felt pain along his medial calf when lunging forward for a hit. You decide to ultrasound the area of concern.

May 28, 2025

C1, Do One, Teach One

A 16-year-old high school football player presented to the ER after being tackled and contacting helmet-to-ground. He was diagnosed with a concussion by a sideline physician . The patient noted dizziness, foggy thinking, and neck stiffness that he had difficulty localizing, but he and parents felt his symptoms were improving. He remained on the sideline and was ambulatory until the conclusion of the game, but as he cooled down his neck became stiff and painful, prompting ER evaluation. Patient denied any radiating symptoms or loss of consciousness. Physical exam was remarkable for pain at terminal flexion and extension, glazed over appearance, but strength and sensation intact.

May 21, 2025

Skier Vs. Tree

A 19-year-old female presents to the ER via EMS after running into a tree while skiing. She says she swerved to avoid a fallen friend, skied off the trail, and hit a tree directly with her back. She has pain in her lumbar spine, but denies any numbness, tingling, or weakness. She says she cannot walk secondary to the pain. Her physical exam is notable for lumbar spine tenderness, with a normal distal neurovascular exam.

May 14, 2025

Small Jumps, Big Breaks

A previously healthy 7 year old male was downhill skiing and jumped off a ski feature, called a box, landing on his right leg. He developed immediate pain in his mid tibia and was unable to bear weight on his right leg. On arrival in the ED he has tenderness over the mid tibia with edema and ecchymosis. No tenderness over the ankle, knee, femur and no evidence of injury elsewhere. He is Neurovascularly intact distal to the injury. XRs of the tibia were done in the ED (Image 1).

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