Ortho EM Pearls

Tolerate More Than Pain

Dancing Till You Drop

A 21-year-old female presents to the emergency room after falling from dancing on a table and injuring her right ankle. She is in severe pain and unable to bear weight comfortably with swelling and tenderness along the lateral malleolus. X-rays are taken and shown above.

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February 25, 2026

Dancing Till You Drop

February 18, 2026

Stop Saltering That Harris

A 13-year-old male presents to the ED after being tackled while playing football and having sudden onset of pain in the knee. He noticed a deformity and was unable to ambulate after the injury.

February 11, 2026

Under Extended

A 45-year-old male presents as a polytrauma patient after a high speed MVC. He was unrestrained and airbags didn't deploy. After a full trauma evaluation, he complains of right knee pain and has developed bruising and an effusion in the right knee since arrival. He was unable to hold a straight leg raise when asked.

January 24, 2026

Shouldererger

January 07, 2026

Chest Goes Crunch

A 45-year-old male presents to the ED with left-sided chest pain after falling off a 10-foot ladder.

December 31, 2025

Fracture Keeps Hurting

29-year-old presented to the emergency department with diffuse left lower-leg pain, swelling, and difficulty with mobility eight weeks after an inversion ankle and knee injury resulting in a known proximal fibular avulsion fracture. He reports wearing both an ankle brace and a knee immobilizer and has remained on protected weight bearing throughout this period with limited mobility.

December 27, 2025

Chest

A 62-year-old male presents with left shoulder/chest pain after falling and landing on the left shoulder. He has pain in the upper chest and describes a deformity.

December 10, 2025

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.

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.

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