Tolerate More Than Pain
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.

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Splinting Series
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.
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Notch Your Average Sign
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.
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Popeye’s Peril: The Biceps Blowout
June 22, 2024
Procedure Ankle
A 45-year-old male with a history of gout is complaining of ankle pain and swelling. His right ankle started swelling a few days ago and has pain with movement. You perform an ultrasound.
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Procedure Ankle
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.
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MCP, are you with me?
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.
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The Forgotten Joint
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.
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A Real Kick in the Hip
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.
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Open Up That Fracture
May 25, 2024
Finger/Digit
A 45 year old male is complaining of swelling and finger pain. He has noted redness of finger and pain with extension. You obtain an ultrasound image over the area of most concern.
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Finger/Digit
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
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Mid-shafted
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.
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Acute on Chronic A-vault-ion Injury
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.
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Hold Your Horses!
May 04, 2024
Distal Wrist
A 43-year-old male is complaining of right shoulder pain after a fall playing pickup soccer. You obtain an ultrasound image (Image 1) of the area with the findings below. What is your diagnosis? Can you identify the structures? A comparison image (Image 2) of the left unaffected shoulder is also provided.
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Distal Wrist
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.
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Watch That Ankle Like a Hawk
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.
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Sorry, Caught it on Your Jersey
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.
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Higher the Pressure Higher the Stakes
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.
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Ankle Breakers
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).
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Neck Tears
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.
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Is That My Toe?
March 23, 2024
Shoulder
A 43-year-old male is complaining of right shoulder pain after a fall playing pickup soccer. You obtain an ultrasound image (Image 1) of the area with the findings below. What is your diagnosis? Can you identify the structures? A comparison image (Image 2) of the left unaffected shoulder is also provided.
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Shoulder
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.
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But it’s my Shoulder!
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