Ortho EM Pearls

Tolerate More Than Pain

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.

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July 16, 2025

The Swelling That Would Not Go Away

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).

May 13, 2025

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.

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.

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