Ortho EM Pearls

Tolerate More Than Pain

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.

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June 11, 2025

Tri Not to Fall

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.

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.

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