Weekly Cases

Weekly Cases Recent articles

Weekly Cases

October 30, 2024

In a Jam

A 20 year old soccer player with left great toe pain, swelling, and bruising after a kick in a game the previous night where he stated “I jammed my toe.”

October 23, 2024

Only sort of broken

A 9-year old male soccer goalie presented to the emergency department with a complaint of forearm pain following a fall on outstretched arm during practice. Pain was located in the mid-distal radius, proximal to the wrist. There was minimal pain with wrist flexion and extension. No pain with movement of the elbow. There is significant tenderness to palpation in a small area of the mid-distal radius without any tenderness proximal or distal to this area. No deformity of the forearm noted. Bedside ultrasound (Image 1) of the area of tenderness is shown below.

October 16, 2024

The Other Type of Pediatric Knee Pain

A 9-year-old previously healthy male presented to the emergency department with anterior knee pain after kicking a ball at school. Patient was ambulatory at the school and in the ED although limping due to pain. Patient is an avid soccer player and has not had any previous knee injuries or issues related to knee pain. Physical exam showed a normal appearing knee with point tenderness at the inferior pole of the patella and proximal patellar tendon, painful but intact knee extension and painful ambulation with some mild limping. Distal neurovascular exam intact.

October 09, 2024

Shouldering Too Much of the Load

A 13-year-old male with no PmHx presents with 3 weeks of progressive shoulder pain. No direct trauma or injury was reported, but the patient reports that the pain began after pitching in a game in which he threw more pitches than usual and during which he exceeded his pitch count. Physical examination was remarkable for significant tenderness to palpation on the lateral aspect of the proximal humerus. Intact ROM and strength, no clavicular or acromial tenderness.

October 02, 2024

Arcuate Sign

A 50-year-old female patient presents to the ED with left knee pain after suffering a hyperextension injury to the left knee. She was walking down steps and reports she internally rotated and hyperextended the knee with immediate pain.

September 25, 2024

Not So Typical Hip Dislocation

A 20-year-old female presents to the ED after MVC with left hip pain. Notably her leg was up on the dash of the car when the accident occurred. Unable to ambulate since the accident and her pain is constant and worse with attempted movement. She notes muscle spasms around her left hip region. She was lying on the stretcher with the affected lower extremity abducted, slightly flexed and externally rotated without obvious shortening. On log roll testing she reported significant pain especially in the anterior groin region.

September 19, 2024

Time is Tissue

A previously healthy 14-year-old right-handed male presented to the children’s emergency department with acute onset swelling of the left hand. He awoke in the morning with left palmar swelling and purple discoloration. Over a few hours, the patient’s swelling spread to the distal fingertips and proximally to the left distal forearm. He denied any IV drug use, use of steroids, or recent trauma. Upon arrival at the ED, the patient was hemodynamically stable and afebrile, but his left wrist and fingers were in a flexed position and held upright against the gurney at rest (Image 1). The patient had prominent circumferential swelling from his distal forearm to the fingertip with diffuse tenderness to palpation along the volar forearm, wrist, and hand. He was unable to actively extend his left wrist and digits due to pain. With passive wrist and finger extension, he reported excruciating pain.

September 11, 2024

Bent my bars and my wrist

A 32-year-old female presents to the ED for right wrist pain after a crash in a rock garden during a downhill mountain biking race. She has significant pain in her right wrist but denies any other pain or symptoms including numbness or tingling.

September 04, 2024

Not So Simple Ankle Dislocation - Sub Talar Trauma

A 45-year-old male was involved in a high-speed interstate MVC rollover accident. Left lower extremity with obvious deformity and open injury.

Not So Simple Ankle Dislocation - Sub Talar Trauma

August 28, 2024

Back it Up - Addressing Low Back Pain

A 58-year-old male presents to the Emergency Department complaining of low back pain, progressively worse over the last few days. He states that he first noticed the pain after work about two weeks ago and seems to be worse with movement. He has tried heating pads and tylenol with little improvement.

August 21, 2024

Cutting Edge Blade Encounters: A Review on Hand Anatomy

A 56-year-old male patient presented to the ED after sustaining a circular saw injury to his left hand. He is right hand dominant. The saw lacerated the palmar/volar surface from the wrist joint to the proximal phalanx of the thumb. On exam he is able to extend against resistance with his thumb at the IP joint, is able to cross-fingers/abduct fingers against resistance, but is unable to initiate palmar abduction of the thumb as well as flexion of the thumb IP and index DIP (“A-OK sign”). He also reports decreased sensation throughout the thumb.

Cutting Edge Blade Encounters: A Review on Hand Anatomy

August 14, 2024

Ditch Dislocation

A 46-year-old male fell into a ditch at a height of approximately 6-7 ft per EMS. He presented to the ED with obvious left ankle deformity seen below.

July 31, 2024

Snap and Shift: The Hip Avulsion Saga

A 15-year-old male presented to the emergency department with acute left hip pain after playing basketball. The patient experienced a sharp pain in the left anterior hip after making an abrupt twisting movement while trying to take the ball from his opponent and is now unable to bear weight. He denies numbness, tingling, or other traumas, but reports left leg weakness and pain.

July 24, 2024

Could You Lend Me a Hand?

An 18-year-old presents with R hand pain and swelling after a tackle resulted in him landing on his hand with his full weight during a rugby match. His x-ray is below.

July 17, 2024

Twist and Shout: A Stressed Out Ankle

A 20-year-old female presents with right ankle pain after a ground level mechanical fall. She has tenderness to palpation of her right lateral malleolus with associated swelling. She was unable to ambulate after her fall.

July 10, 2024

Behind the Knee Pain

A 44 year old male with a PMHx of hypertension, presents to the emergency department with a 3 month history of right knee pain and swelling. Patient installs carpet for a living. Pain is worse when kneeling, better with rest. Patient has taken ibuprofen intermittently for symptomatic relief. Patient tried to see his primary care provider but they did not have any openings.

July 03, 2024

Notch Your Average Sign

A 37-year-old female presented to the ED for left knee swelling and pain after a ground level mechanical fall with possible twisting injury. Patient states she was pushed to the ground and struck her left knee on the concrete, feeling immediate pain and swelling.

June 26, 2024

Popeye’s Peril: The Biceps Blowout

A 38 year male with no significant past medical history presents for right elbow pain after a skydiving injury. He states that while he was trying to adjust his chute, a gust of wind caught his chute and his arm was jerked straight and he thinks he heard a pop. He has pain and weakness with opening jars. He denies numbness or tingling. On exam his arm appears like Image 1. He has ecchymosis on the medial aspect of his arm. Motor strength reveals 4 / 5 flexion and 3 /5 supination with pain. When his arm is flexed to 90 and he supinates against resistance, there is no cord-like structure on palpation. Radiographic imaging is normal.

June 19, 2024

MCP, are you with me?

A 50-year-old right-handed male presented to the emergency department with finger pain in his right hand following a fall. The incident occurred as he was disembarking from a cruise ship and tripped while descending an escalator, resulting in a tumble. The patient's sole complaint is pain and deformity in his finger.

June 12, 2024

The Forgotten Joint

A 51-year-old man complains of right-sided lower neck/chest pain and deformity after a trip and fall onto his right shoulder while playing basketball. The patient is otherwise asymptomatic. Examination reveals a palpable bump right of the sternum with tenderness to palpation.

June 05, 2024

A Real Kick in the Hip

A 7-year-old male presents with progressively worsening left hip pain and limp when playing soccer. Pain was previously relieved by rest but has now become constant.

May 29, 2024

Open Up That Fracture

A 65 year old farmer presents to the ED after his ankle was run over by a piece of farm equipment in the field. His x-ray is shown below and he has an associated soft tissue injury overlying the area that is grossly contaminated with mud and manure.

May 22, 2024

Mid-shafted

A 29-year-old male presents to the ED with left arm pain after he fell sideways off his bike mountain biking up a steep incline

May 15, 2024

Acute on Chronic A-vault-ion Injury

An 8-year-old dancer presents for acute left knee pain. She has had atraumatic anterior pain in this same knee over the last 6 months that was worse with activity. Today however she had acute severe pain after vaulting a stunt. She points to the anterior knee and is not wanting to walk.

May 08, 2024

Hold Your Horses!

A 22-year-old female presents to the Emergency Department with traumatic left 5th digit pain. She was in a horse racing competition when she awkwardly pinned her hand against the back of her horse. On exam, there is an obvious deformity of the 5th digit with tenderness to palpation of the proximal phalanx. Patient has diminished sensation to the fingertip. She has good capillary refill and no evidence of open injury.

May 01, 2024

Watch That Ankle Like a Hawk

A 16-year-old male was transferred from an outside hospital to the emergency department with severe right ankle pain after landing awkwardly in ankle inversion, while playing volleyball. He was unable to walk and had right ankle deformity. On exam, he had a normal distal pulse and capillary refill, intact sensation, and could move his toes. Plain films of the patient’s right ankle were obtained.

April 24, 2024

Sorry, Caught it on Your Jersey

A 19-year-old male D1 football player presents with left ring finger pain and inability to flex the DIP joint after getting his finger stuck on an opponent's jersey during the game last night.

April 17, 2024

Higher the Pressure Higher the Stakes

A 37-year-old male presents after accidentally shooting a high pressure paint gun into his right index finger at work. The paint was water based. He denies pain, there is no swelling, and he has full range of motion without pain at arrival to the ED.

April 10, 2024

Ankle Breakers

A 49-year-old female presents with right ankle pain after a ground level fall. She has been unable to ambulate since the incident. On exam, there is mild swelling to the distal ankle with tenderness to palpation of the lateral malleolus. Plantar- and dorsiflexion of the ankle are limited due to pain. There are no open wounds visualized and the ankle is warm and well perfused.

April 03, 2024

Neck Tears

A 40-year-old male presents with neck pain after a high speed motor vehicle collision. You obtain x-rays (Image 1).

March 27, 2024

Is That My Toe?

A 40-year-old female presents for left 1st toe pain. She had her toes curled when someone stood up and pushed off of her, pushing her toes into the ground and creating a deformity.

March 20, 2024

But it’s my Shoulder!

Patient is a 55 year old male presenting to the ED with right shoulder pain. He states the pain has been ongoing for several weeks and worsening over time. He does not have any point areas of pain, but describes it as more diffuse. There are no aggravating or relieving factors.

March 13, 2024

Un-lucky back pain

A 35 year old male is BIBA after MVA. The patient was wearing a lap belt without a shoulder harness and is now complaining of abdominal and back pain. Physical exam shows an abdominal seatbelt sign with pain in the abdomen and upper lumbar spine. CT is shown below.

March 06, 2024

Bowing out of the Tournament

A 15-year old male presents with right elbow pain and deformity after injury sustained during a wrestling tournament. He has a large joint effusion and prominent olecranon, and is otherwise neurovascularly intact.

February 28, 2024

Stepping into Understanding: Navigating the World of Navicular Stress Fractures

A 24-year-old male basketball player presents to the ED with right dorsal mid-foot pain after a week of daily intensive practices. The pain is worsened by use. Dorsalis pedis pulses are 2+ and the range of motion/sensation of the foot is intact.

Stepping into Understanding: Navigating the World of Navicular Stress Fractures

February 24, 2024

Water Bath Technique

A 37 year old male is complaining of left hand pain after he got a wooden splinter in it 3 months ago. You obtain an ultrasound image of the area using a water bath technique with the findings below.

February 21, 2024

Stuck in the Shoulder: Thawing Out the Mystery of Shoulder Pain

A 54-year-old female with a history of type 2 diabetes presents to the ED with severe left shoulder pain after she woke up this morning. She denies any falls or trauma. On exam, she has marked reduced range of motion in all planes, most notably 25° with external rotation. Radiograph reveals the following:

Stuck in the Shoulder: Thawing Out the Mystery of Shoulder Pain

February 14, 2024

I Just Ran a Marathon and Now I Can’t Walk

A 28 year old male just ran a personal record in the Chicago marathon. The next morning he wakes up with severe pain on the lateral aspect of his left foot. He’s having trouble bearing weight and walking due to the pain. He goes to a walk-in orthopedic clinic and an X-ray of his foot is shown below.

I Just Ran a Marathon and Now I Can’t Walk

February 07, 2024

Tolerate More Than Pain

A 10-year-old male presents for right wrist pain after a fall while snowboarding. There is pain, swelling, and a deformity but he is neurovascularly intact.

January 31, 2024

The Tooth of the Cervical Spine

An 80 year-old male patient BIBA for a witnessed fall. Cervical collar was placed by EMS because of midline neck pain. Patient is neurologically intact. CT of the cervical spine is shown below.

January 24, 2024

Kitchen Nightmares

A 44-year-old male presents with a left finger laceration sustained while cutting vegetables. He is right-hand dominant and up-to-date on his tetanus. On exam, there is a 3 cm zone 2 laceration across the base of the left pointer finger. The patient is unable to flex the affected digit at both the DIP and PIP joints. He endorses diminished sensation to the distal fingertip. He has good capillary refill and no evidence of arterial bleeding.

January 17, 2024

Where’d that tree come from?

A 29-year-old male presents to the ED with shoulder and back pain. He was lying in a hammock when the tree it was attached to broke and fell on top of him.

January 10, 2024

Not So Humerus

An 87-year-old woman presents after a mechanical fall onto her outstretched right arm. Physical exam showed swelling of the upper right arm from the elbow to shoulder and palpable deformity. Radial and ulnar pulses are 2+ and gross sensation is intact in the right upper extremity.

January 03, 2024

Twisting Tales: Unraveling the Complexities of the Galeazzi Fracture

A 30-year-old male presents to the ED after a motorcycle accident. You find a wrist deformity on his exam. There is a 2+ radial pulse and motor/sensation of the hand is intact.

Twisting Tales: Unraveling the Complexities of the Galeazzi Fracture

December 27, 2023

Stings Like a Bee

A 16 year old male presents to the ED with complaints of right upper extremity weakness, pain, and paresthesias after falling and striking his head during a football game. No loss of consciousness.

December 20, 2023

No Longer Hip

A 77-year-old female with past medical history significant for Parkinson’s disease and hypertension presents to the ED after a mechanical fall upon getting into bed. Since that time, she has endorsed left hip pain and inability to ambulate.

December 13, 2023

The Gas Pedal is Connected to the Heel Bone

A 36-year-old male was involved in a motor vehicle collision. The patient was the restrained driver in a head-on collision at highway speeds. He experienced bilateral heel pain. Plain films of the patient's left and right calcaneus were obtained.

The Gas Pedal is Connected to the Heel Bone

December 06, 2023

A Real Pain in the Butt

A 26-year-old golfer presents with left gluteal pain and paresthesias to the lower leg. Symptoms have been ongoing for the 2 weeks but acutely worsened after a ground level fall while trail running. He has a positive straight leg and crossed straight leg test, as well as weakness with dorsiflexion of the big toe and ankle.

November 29, 2023

Hips Don’t Lie

A 73 year old male presents to the ED with chief complaint of right hip pain. He reports no injury or falls. He states he attempted to rise out of his vehicle just before going to physical therapy. He endorses he went to lift his right leg slightly and stated, “I felt a pop.”

November 22, 2023

Foosh There It Is

A 32 yo M patient presents after a fall from his bike. He braced his fall by extending his right arm to absorb the impact. He complains of persistent pain on his thenar eminence and is able to flex and extend his wrist. He experiences increased pain with axial loading on an extended wrist. Plain films of the patient’s right hand were obtained.

November 15, 2023

Diver’s Nightmare

A 27 year old male presents with neck pain after diving headfirst into shallow waters. He has midline tenderness and a normal neurological exam. CT of the cervical spine is shown below.

November 08, 2023

My Bladder, My Back

68 year old male PMH significant for diabetes, spinal arthritis, and recurrent urinary tract infections presents to the Emergency Department with 5 weeks of dysuria and low flank pain. He reports subjective fevers and chills, but denies nausea, vomiting, or trauma. Plain films of the lumbar spine were obtained (Image 1).

November 01, 2023

When Striking the Right Cord is Just Too Painful

A 45 year old male guitar player comes into the clinic due to pain in his right 5th finger on the lateral aspect. He describes the pain is worse when playing guitar, especially when his fifth finger is over the cord he is playing. He reports he visited a local ER about one week ago following a fall from his bike, where he had plain radiographs taken and was sent home without care instructions. Exam shows minimal tenderness to palpation over the radial PIP joint of the 5th digit, otherwise nontender. Significant laxity is present when valgus stress is applied to the PIP joint of the finger.

When Striking the Right Cord is Just Too Painful

October 25, 2023

Get a Grip

A 23 year-old male presents to the emergency department for right hand pain. He was downhill skiing when he got tangled in his poles and fell onto his outstretched hand. He has ongoing pain at the base of his thumb, aggravated by gripping objects. He denies numbness or tingling.

October 18, 2023

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.

September 13, 2023

Metatarsal Madness

A 57-year-old female presented to the emergency department with complaints of severe pain in her right foot after twisting her ankle earlier today. She denies any numbness or tingling, but has had difficulty walking due to the pain.

September 06, 2023

2 for the Price of 1

An 11 year old male presents to the emergency department after falling off of the monkey bars. He landed on his left arm and felt immediate pain.

August 30, 2023

The Middle Finger

A 15-year-old female sustains a jammed right middle finger while playing basketball. She presents to the ED with pain and swelling over the volar aspect of the proximal interphalangeal joint. X-ray is as follows below.

August 23, 2023

My Foot Hurts Severely

A 10-year-old boy presents to the Emergency Department with heel pain. The pain has been ongoing for the past two months but acutely worsened after his soccer game today to the point where he had to stop playing. He denies any preceding trauma.

August 16, 2023

A Bad Trip

A 76 yo female presents to the ED with a complaint of left wrist pain after a witnessed mechanical ground-level fall on cobblestone 1 hour ago. She endorses worsening discomfort in the left wrist, with some numbness of her left fingers. Her left wrist is tender to palpation with an obvious deformity. There is a wound overlying the deformity.

August 09, 2023

All I did was push off

15 year old male with left shin pain. He reports he fell off his skateboard at low speed. When he got up and pushed off the ground to move forward felt sudden pain that he thought was a rock hitting his shin. He has been unable to ambulate since that time.

August 02, 2023

Tales of a Wayward Screw

A 52 year old male presents with left knee swelling and pain for the past 5 days. Patient denies recent trauma to his leg but reports a history of gout with similar symptoms. He also mentions a distant tibial fracture of the same leg for which he underwent ORIF. Pain is well localised to the medial tibial plateau area and is limiting ability to ambulate. Patient denies fever or chills, but states the area has been turning red for the past day. Visual examination of the knee reveals an area of erythema with small central ulceration which is exquisitely tender to palpation. (Image 1a). There is full active and passive range of motion of the knee, but with pain on both complete extension and complete flexion.

July 26, 2023

Confusion Over a Contusion

A 20-year-old female presents to the Emergency Department for progressively worsening right thigh pain after a motor vehicle collision two weeks ago in which she was an unrestrained front passenger. Examination of the right lower extremity demonstrates a fluctuant collection that is tender to palpation along the lateral and posterior thigh. There is no erythema or warmth, the compartments are soft, and neurovascular examination is normal. Plain films of the femur and knee show no acute fracture or dislocation.

July 19, 2023

Man this Meniscus Blows

A 51-year-old female presented to the ED with right knee pain after she was putting her grandchildren to bed, felt her knee twist and “give out,” then felt and heard an immediate pop accompanied with severe pain. She was unable to ambulate following the injury. She endorses increased swelling worse on the medial aspect of her knee. X-ray performed in the ED had no acute findings. Exam revealed medial joint line tenderness.

July 12, 2023

Looked O.K. to Os

A 29-year-old female presents with acute left ankle pain and swelling after tripping at the bottom of a staircase. She described a mechanism of injury (MOI) of inversion and hyperplantarflexion of her left ankle. Her symptoms began immediately and she had significant difficulty bearing weight.

July 05, 2023

The Arch Nemesis

A 19 year old man with no PMH comes in for significant left foot pain after a football game. He is an offensive lineman and was removed from a football game after the running back fell directly onto his heel causing him immediate pain and inability to bear weight.

June 28, 2023

Tales of the Swollen Elbow

A 48-year-old female presents to the emergency department due to worsening L elbow pain, swelling, and redness. Endorses subjective fevers. She was learning to surf around a week ago and thinks she may have cut her elbow on the board. She has been taking NSAIDs, icing the area, and using a compressive bandage but it has not improved.

June 21, 2023

Mr. Jones and my Foot

A 21 year old male presents to the emergency department with sudden onset lateral foot pain. He states that he was making a cut while playing football when he suddenly had pain. He has not been able to bear weight on the affected foot since the incident.

June 21, 2023

You Make Me All Tingly

A 31 year old obese female presents to the clinic with complaints of numbness and tingling in her hand that has been waking her up at night. Her numbness and tingling is limited to the palmar side of her hands over the first 3 digits. She works as a computer programmer. Her wrist ultrasound is shown below.

June 07, 2023

Synovium, on the Rocks

A 45-year-old male presents with left knee pain and swelling that has been progressively worsening over the last 6 months. He has limited ROM, crepitus, and large joint effusion on exam. Denies recent injury or history of surgery. He was told he had “too many bones in his knee” years ago when he had an x-ray of his knees after a car accident.

May 31, 2023

How Deep is that Laceration?

38 year old male was using a reciprocating saw to cut baseboards when the saw jumped and the blade cut into the side of his knee. He reports difficulty with ambulation and flexion of the knee.

May 24, 2023

Foosh There it is

A 72 year old woman presents to the emergency department with right wrist pain and swelling. She states that she was crossing the street when she fell and attempted to brace herself with her right hand.

May 17, 2023

All Stressed Out: A Runner’s Story

A 19-year-old female collegiate cross-country runner presents with calf pain that has progressed from pain with running to pain when walking. She has increased training throughout the summer, running approximately 50 miles a week. She is diagnosed with a tibial stress fracture, what underlying disorder should you consider?

May 10, 2023

All Pain and No Gain

May 03, 2023

Y We Got Another - A two part series

A 60-year-old male presents to the ED with 1 week of right shoulder pain and limited mobility after a ground level fall on an outstretched hand. His x-ray is shown below.

April 26, 2023

My Finger Isn’t Working Right

A 27 year old male presents with a laceration to his right hand. He works as a carpenter and was using a circular saw when he cut his hand. Bleeding is controlled, however he is having trouble moving his index finger. An ultrasound of his palm is shown below.

April 19, 2023

Bumpy Road Ahead

A 52-year-old female presents with pain at the back of her right heel. The pain has been chronic for years and initially did not bother her as much, but has been worsening over the past few months after she has started walking more often for exercise. The pain is worse with palpation and after walking long distances. She denies any injury to the heel, although does endorse having had a childhood injury of Achilles tendon rupture and repair.

April 12, 2023

Honey, I Swung Our Kid

A three year old male presents after refusing to move his right arm. According to the patient’s father, this started shortly after they were playing together and he swung him around by his arms.

April 05, 2023

Kick, Push, Kick, Push, and Crack

A 32-year-old male presents with right dorsolateral foot pain after rolling his ankle while skateboarding. While attempting a “fakie kickflip”, his right foot suffered an inversion injury off the board and he had immediate subsequent swelling (Figure 1), dorsolateral foot pain, and inability to bear weight . He had significant tenderness to palpation near his isolated swelling at the dorsolateral foot, proximal to the base of the 5th metatarsal. X-ray of his right foot is performed.

March 29, 2023

So Swole

A 26-year-old male hockey player presents to the emergency department with complaints of swelling and pain in his left elbow. The patient reports that he fell on his outstretched hand during a game two days ago and has been experiencing increasing elbow pain and swelling since that time.

March 22, 2023

A Real Pain in the Neck

A 45-year-old male presents with acute right-sided neck pain associated with odynophagia and trismus. On examination, the patient has limited neck mobility due to stiffness. A CT soft tissue neck with contrast was performed and demonstrated the above image.

March 15, 2023

Roses are Red, Violets are Blue but What Do I Do if My Hand is Blue Too

A 66-year-old female with a history of hypothyroidism and migraines presents with progressive numbness, coolness, and discoloration of her right second through fourth fingers. She notes improvement when hands are placed in warm water and worsening of symptoms when hands are above her head. She was recently treated for Raynaud’s syndrome by her primary care physician. She has a remote history of right shoulder dislocation.

Roses are Red, Violets are Blue but What Do I Do if My Hand is Blue Too

March 08, 2023

A Missed Connection

A 45-year-old female presents with sudden onset of left thigh pain. Denies trauma to the area.

March 01, 2023

Do You Want Salt With Those Fries?

A 5 year old female presents after falling awkwardly. She presents with a limp and pain over her lateral ankle.

February 22, 2023

Monkey Bar Mania

A 6-year-old male presents with right wrist pain after falling from the monkey bars.

February 15, 2023

Hey Batter Batter

A 25 year-old male presents to the ED with left hand pain that started after batting practice. Exam reveals tenderness over the hypothenar eminence.

February 08, 2023

Man Down After a Line Drive

A 16 year-old baseball player collapses after being hit in the chest by a line drive. He remains motionless on the ground. The medical team immediately recognizes he is in cardiac arrest and begins CPR. During pulse check, the rhythm strip on the cardiac monitor is shown below.

February 01, 2023

Doggone It!

A 60-year-old female presents for left knee pain after falling when her dog’s leash got tangled up with another dog. She is most tender along the left lateral side of her knee and denies any numbness or weakness.

January 25, 2023

It Just Keeps on Slippin’

18 year old male presents to the ED with knee pain. He was playing basketball when he reached to get the ball, and his knee gave out and he felt something pop. He states that he thinks he dislocated his knee.

January 18, 2023

OCD about the Talar Dome

A patient presents to the Emergency Department with difficulty bearing weight on the right lower extremity after sustaining an inversion injury to the right ankle just prior to presentation. On exam she has moderate right ankle swelling. She is tender over the anterior joint line, particularly laterally. There is no bony tenderness of the malleoli, the calcaneus, the navicular, or the 5th metatarsal. There is no tenderness over the Lisfranc joint. She is tender over the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). No tenderness with tib-fib compression testing. Right ankle x-rays are obtained (Image 1).

January 11, 2023

Up, Up, and Blown Away

A 28-year-old male presents to the ED with vertigo. He just returned to Denver from The Greater Antilles after a celebratory scuba diving trip. He reports ear pain after his last dive today and upon descending into Denver, he felt a pop with relief of pressure in his right ear and onset of vertigo.. His otoscopic exam is shown in the image below.

January 04, 2023

I Hope This Will Heel

50 year old female who presents to the ED with R heel pain. She states that she was on a step stool when she lost her balance and fell directly on the heel of her foot. No other pain or injuries.

December 28, 2022

Ankles Crossed Up

A 26 year old male year presents with right ankle pain after jumping out of a truck at work. There is significant effusion and generalized lower leg pain but no obvious deformity.

December 21, 2022

Ankle Pain - A Twist

A 24 year old male presents with sudden onset left ankle pain after playing soccer. His foot was planted when another player collided with him. He is unable to bear weight.

December 15, 2022

Why does that elbow still hurt

4-year-old female presents with right arm pain. She fell onto an outstretched hand and immediately complained of severe pain. The injury occurred two days ago and has not wanted to use her arm since.

December 07, 2022

The Wall

A 26 year old male without significant medical history presents to the ED with left hand pain. Patient states that he was in an argument and punched a wall in frustration.

November 30, 2022

You’re Driving Knee Crazy

A 70 year old female presents with knee pain after high speed MVC. Patient felt a “pop” in her knee as it made contact with the dashboard. The “pop” was followed by severe pain and inability to move her right knee. She is tender over her right knee with obvious deformity.

November 23, 2022

Please Pass the Salt

A patient presents to the Emergency Department endorsing fatigue, malaise, nausea, and headache after completing his first marathon. It was a hot, humid day with a wet bulb globe temperature (WBGT) of 87. He was concerned about dehydration so drank as much water as possible at each hydration station. His partner reports he is confused since finishing. On exam, he is pale and diaphoretic with moist mucous membranes. He is awake, alert, and oriented to self and place but not to time or events.

November 16, 2022

Fracture in Process

A 67-year-old male presents as the restrained driver in an MVC with L elbow pain and swelling.

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.

Ortho EM Pearls is a 501(c)(3) nonprofit organization.