Ortho EM Pearls

Tolerate More Than Pain

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.

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August 28, 2024

Back it Up - Addressing Low Back Pain

August 24, 2024

Anterior Elbow

A 67-year-old male is complaining of left upper arm swelling after lifting a heavy object. He has noted a deformity to his upper arm. You obtain an ultrasound image over the area of most concern.

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 27, 2024

Procedure Knee

A 63-year-old male with a history of R total knee replacement is complaining of knee pain, redness, and swelling. His knee started swelling a few days ago and has pain with flexion. You perform an ultrasound and notice a large effusion. To assist with diagnosis, you opt to perform a knee arthrocentesis.

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 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.

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 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.

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.

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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.

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