Ortho EM Pearls

Tolerate More Than Pain

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.

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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!

February 23, 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.

January 08, 2025

The Heel Deal

A 57-year-old male with a history of alcohol induced cirrhosis presents to the ED w/ 10 days of reported L foot pain after fall from 6 foot ladder, landing directly onto his left foot. Since his injury, he has noticed increasing redness and swelling to the posterior aspect of the foot beginning approximately 4 days after the fall. He has been using a walker that he borrowed from his friend to assist in ambulation. He denies any knee pain or back pain.

December 28, 2024

Regional Anesthesia Upper Extremity

A 24-year-old male presents after a high-energy ATV rollover. He presents with a gross deformity to his forearm.

December 25, 2024

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.

December 18, 2024

Red Hot Wrist

The patient is a 74-year-old male with a PMH of diabetes, and hypersensitivity pneumonitis on chronic prednisone who presented with fevers and right wrist pain. He had a cortisone injection in his right wrist 4 days prior. The patient reports pain, swelling, and erythema of the right wrist. Pain is worse with movement. He denies trauma to the wrist. His distal neurovasculature is intact. He is febrile to 38.5C, tachycardic (HR:130), tachypnic (RR: 25), and hypoxic requiring oxygen (85% room air).

December 04, 2024

To Immobilize or Not to Immobilize: That is the Question

A patient presents to the Emergency Department after sustaining a twisting knee injury while skiing. She felt a pop and was unable to bear weight afterwards secondary to pain and instability. Shortly after the injury, she noted increased swelling and pain. On examination, she has a moderate effusion and a positive Lachman test.

To Immobilize or Not to Immobilize: That is the Question

November 27, 2024

Pain in the Butt

A 48-year-old female with no pertinent past medical conditions presents for ongoing pain in the gluteal region which is worse on the right compared to the left. Pain is dull/aching in nature but at times describes it as a burning sensation. She denies any recent trauma. She states it is worse when lying on her side, when she goes for a jog, and when she squats. She has been taking non-steroidal anti-inflammatories (NSAIDs) but states the pain has been getting more and more prominent. On exam, she has point tenderness along the right lateral hip. She has a negative straight leg test, and a positive FABER. X-ray of the hip seen below in Image 1 was obtained which was unremarkable.

November 23, 2024

Regional Anesthesia Lower Extremity Part 1

A 67-year-old male with diabetes stepped on a metal object and is complaining of ongoing heel pain. You obtain the below X-ray.

Regional Anesthesia Lower Extremity Part 1

November 20, 2024

Foot Doesn’t Work Right

A 35-year-old male felt a painful “pop” in his posterior left lower leg while playing football. Afterwards his “foot didn’t work right anymore.” X-ray of the left ankle and tib/fib are normal but he is unable to ambulate. You place an ultrasound over the area of maximal tenderness and discover the following:

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