Ortho EM Pearls

Tolerate More Than Pain

One Wheelin' and Dealin'

A 45-year-old male presents to the ED complaining of left shoulder pain after falling off of his Onewheel. There is an obvious deformity noted to the left anterior/superior chest with decreased range of motion of the shoulder.

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December 10, 2025

One Wheelin' and Dealin'

December 03, 2025

My Arm is Stuck Like This

A 70-year-old female presents with right shoulder pain and inability to adduct her arm after she fell on the sidewalk.

November 29, 2025

Wrist

A 47-year-old female notes radial wrist pain for a few weeks after caring for her newborn.

November 26, 2025

Don't Forget About the (Tibial) Spine

A 13-year-old patient presents to the Emergency Department after sustaining a twisting knee injury while playing soccer. There was a pop, and the patient was subsequently unable to bear weight secondary to pain and instability. In the hours following the injury the swelling and pain increased. On examination, there is a large knee effusion and a positive Lachman test.

November 19, 2025

El-bow Out of This One

A 65-year-old male presents with left elbow and forearm pain and deformity after falling on the soccer field when attempting a scissor kick. He fell onto his outstretched arm with his elbow flexed and supinated.

November 12, 2025

This Little Piggy Went to the Hospital

A 74-year-old female presents with right foot pain after tripping on a shoe. She reports discomfort on the lateral side of her foot with weightbearing.

November 05, 2025

Tap the Joint

A 61-year-old male presents with a swollen, painful left knee he is unable to flex or extend. He endorses fever but denies trauma or wounds. His knee is warm, erythematous, and edematous.

October 29, 2025

A Shock Down the Leg

A 65-year-old male presents to the ED with acute-on-chronic left lower back pain that radiates down to his left foot. The pain is described as a shocking sensation. His symptoms started three days ago and have not improved with Ibuprofen at home. The patient denies trauma, bowel or bladder incontinence, saddle anesthesia, IV drug use, steroid use, fever, or unexplained weight loss.

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.

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