Ortho EM Pearls

Tolerate More Than Pain

Not so Hip

An 18-year-old male presented to the Emergency Department after a motor vehicle collision at unknown speeds. Patient was the restrained driver, airbags did deploy, and he’s unsure if he lost consciousness. He is primarily complaining of bilateral hip and right hand pain with notable obligate abduction and external rotation of the right lower extremity on initial inspection.

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May 13, 2025

Not so Hip

April 30, 2025

Segond Thoughts: A Clue to Something Bigger

A 25-year-old male presents with right knee pain after a non-contact pivoting injury during a soccer game; he reports hearing a pop.

Segond Thoughts: A Clue to Something Bigger

April 26, 2025

Dorsal Wrist

A 65-year-old male presents with left wrist pain. He has noted swelling to his left wrist for the past several days. You perform an ultrasound and notice an effusion. To assist with diagnosis, you opt to perform a wrist arthrocentesis. Ultrasound can be a great tool to assist with arthrocentesis. Can you name the structures seen?

April 23, 2025

Pull to Start

A 59-year-old male with a history of DVT on Eliquis presents to the emergency room with severe shoulder pain. The patient had been pushing his car when he fell onto his outstretched arms. His son subsequently pulled on his right arm to attempt to “relocate” it. During this, the patient experienced sudden worsening pain with his right arm becoming stuck above his head with the onset of numbness and tingling in his right arm.

April 16, 2025

Oh Snap

A 14-year-old male presents for left medial elbow pain after pitching during a baseball game the night before when he felt a snap in his left elbow during a pitch. He continued to feel a sharp pain with every subsequent pitch in the medial elbow. He has point tenderness on the medial aspect of his left elbow and pain with elbow extension but full ROM. He has tried OTC anti-inflammatory medications and icing at home with mild relief.

April 09, 2025

Shoulder Check: A common skier's shoulder injury

A 38-year-old female presents to the ski clinic for left shoulder pain after a fall while skiing. Her ski caught an edge causing her to fall directly onto her left shoulder. She now has significant pain in the left shoulder that increases with attempt at forward flexion and adduction at the shoulder. She denies any other associated symptoms.

Shoulder Check: A common skier's shoulder injury

April 02, 2025

The Floating Elbow

A 30-year-old male with no pertinent medical history presented as a trauma after a motorcycle crash where he was traveling approximately 70 mph. The patient was cut off by another vehicle, and flew off his bike going airborne unknown feet, landing onto his outstretched hands. He is primarily complaining of left arm pain.

March 29, 2025

Anterior Knee

A 55-year-old female presents with right knee pain after a misstep and twisting knee injury. She has swelling and deformity of her knee and difficulty extending the knee. You obtain an ultrasound image given the difficult exam.

March 26, 2025

Dropping the Ball

A 20-year-old college basketball player presents to the Emergency Department after a syncopal event at practice. He was found pulseless by the athletic trainer, who initiated chest compressions, and achieved ROSC after delivering 1 shock via AED.

March 19, 2025

A Sudden Turn of the Ankle

A 77-year-old presents to the ED for evaluation of right ankle pain, which occurred approximately 1 hour prior to arrival after making a sharp right turn with his foot planted in the restroom. He had sudden onset pain. He reports normal sensation over the right foot and is neurovascularly intact. An obvious open deformity is noted to the right ankle.

March 12, 2025

Pedal to the Metal

A 32-year-old female presents to the emergency department with right ankle pain after a high-speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the dorsal foot, and pain with ankle dorsiflexion and plantarflexion.

February 26, 2025

Hold On Tight!

A 34-year-old female presents after a waterslide accident. She was traveling down a water slide with her fourth and fifth digits of her right hand in the handle of the inner tube when the inner tube was ripped out from under her at the bottom of the slide. She instantly noted pain and swelling in the middle of her hand. She complains that she can not make a fist.

February 22, 2025

Superior Knee

A 55-year-old male presents with right knee pain after a ski accident. She has swelling of her knee and difficulty bearing weight. You obtain an ultrasound image given the difficult exam.

February 19, 2025

Acute Shoulder Pain After a Fall

An 80 year-old female tripped over her cat at home. This caused her to fall, hitting her right shoulder on the counter on the way to the floor. She is complaining of right shoulder pain and denies hitting her head or LOC. X-rays obtained in the Emergency Department are shown below.

February 12, 2025

Can’t Climb a Tree

A 35-year-old male with past medical history of Crohn’s disease presents to the ED for insidious lower back pain worse with prolonged exertion, climbing stairs, and morning stiffness. He reports some relief with movement and NSAIDs, but the pain has progressively worsened over the past few months.

February 05, 2025

Achilles Heel - Kager’s Fat Pad

A 25-year-old male with no medical history presents with left foot pain after a soccer injury yesterday. He states he was running when he felt a sudden “pop” to the posterior aspect of the left ankle and thought someone had kicked him. He is complaining of mild pain localized to the posterior ankle though has been ambulating with pain.

January 29, 2025

Calf-inated

A 45-year-old male presents with pain in the posterior right calf after falling forward while skiing. He now has pain with ambulation. He has pain with passive dorsiflexion of the ankle, pain with resisted plantar flexion, but preserved plantar flexion with squeeze of calf muscles.

January 27, 2025

Regional Anesthesia Interscalene Block

A 27-year-old male presents with left shoulder pain after falling down a flight of stairs and trying to grab onto a railing to catch himself. He has an obvious deformity to his left shoulder, and is holding his arm in abduction and internal rotation.

January 22, 2025

Too much send

An 18-year-old male presents with left ankle pain after overshooting the landing of a large jump while snowboarding.

January 15, 2025

I declare a thumb war

A 39-year-old female presents to the emergency department with right thumb pain after falling in a skiing accident. On exam, there is mild swelling, tenderness on the ulnar aspect of the 1st MCP joint. Additionally, there is laxity with valgus stressing of the 1st MCP joint.

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All content on the Ortho EM Pearls website is purely educational and should not be construed as medical advice. The content and all associated information on this website is not intended to diagnose, treat, cure, or prevent any disease. Please seek care from a medical professional and if you are having a medical emergency, please call 911.

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