Weekly Cases Recent articles
Weekly Cases
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 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 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 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!
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.
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Un-lucky back pain
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.
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Bowing out of the Tournament
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.
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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.
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Water Bath Technique
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:
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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.
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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.
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Tolerate More Than Pain
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.
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The Tooth of the Cervical Spine
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.
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Kitchen Nightmares
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.
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Where’d that tree come from?
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.
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Not So Humerus
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.
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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.
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Stings Like a Bee
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.
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No Longer Hip
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.
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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.
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A Real Pain in the Butt
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.”
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Hips Don’t Lie
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.
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Foosh There It Is
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.
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Diver’s Nightmare
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).
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My Bladder, My Back
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.
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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.
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Get a Grip
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.
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El-bow Out of This One
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.
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Metatarsal Madness
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.
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2 for the Price of 1
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.
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The Middle Finger
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.
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My Foot Hurts Severely
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.
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A Bad Trip
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.
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All I did was push off
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.
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Tales of a Wayward Screw
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.
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Confusion Over a Contusion
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.
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Man this Meniscus Blows
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.
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Looked O.K. to Os
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.
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The Arch Nemesis
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.
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Tales of the Swollen Elbow
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.
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Mr. Jones and my Foot
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.
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You Make Me All Tingly
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.
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Synovium, on the Rocks
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.
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How Deep is that Laceration?
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.
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Foosh There it is
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?
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All Stressed Out: A Runner’s Story
May 10, 2023
All Pain and No Gain
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.
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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.
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Y We Got Another - A two part series
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.
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My Finger Isn’t Working Right
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.
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Bumpy Road Ahead
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.
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Honey, I Swung Our Kid
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.
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Kick, Push, Kick, Push, and Crack
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.
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So Swole
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.
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A Real Pain in the Neck
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.
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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.
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A Missed Connection
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.
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Do You Want Salt With Those Fries?
February 22, 2023
Monkey Bar Mania
A 6-year-old male presents with right wrist pain after falling from the monkey bars.
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Monkey Bar Mania
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.
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Hey Batter Batter
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.
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Man Down After a Line Drive
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.
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Doggone It!
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.
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It Just Keeps on Slippin’
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).
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OCD about the Talar Dome
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.
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Up, Up, and Blown Away
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.
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I Hope This Will Heel
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.
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Ankles Crossed Up
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.
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Ankle Pain - A Twist
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.
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Why does that elbow still hurt
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.
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The Wall
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.
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You’re Driving Knee Crazy
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.
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Please Pass the Salt
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.
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Fracture in Process
November 09, 2022
You Flail I Wail
A 34-year-old male patient presents after being hit by a car while riding a motorcycle. The patient is in severe respiratory distress and a portion of his chest wall appears to be moving paradoxically to his respirations.
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You Flail I Wail
November 02, 2022
The Great Escape
A 17-year-old male presents to the Emergency Department (ED) with right sided chest pain and shortness of breath. He was playing in his high school football game when he was tackled with the ball between him and the ground. Vital signs are stable.
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The Great Escape
October 26, 2022
It was just a rash…
An 80 year old diabetic female presents for right leg pain. The pain started this morning and has now progressively worsened to severe in the early afternoon. She also notes a blistering “rash” that has been worsening on the leg throughout the day. She denies trauma and did not have pain or skin changes prior to today. Vitals are currently stable.
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It was just a rash…
October 19, 2022
Hips Pop and Drop
A 13-year-old female softball player presents to the emergency department with left hip pain. She reports her pain started while she was running to first base. She has significant pain with walking or trying to bear weight. The exam is remarkable for point tenderness over the left pelvis but she is neurovascularly intact.
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Hips Pop and Drop
October 12, 2022
En Pointe
A 32-year old female presents to the emergency department with right foot pain after rolling her ankle during dance class. On exam there is mild swelling and tenderness over the 5th metatarsal.
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En Pointe
October 05, 2022
Hip, Hip, Hooray!
A 67-year-old male with a history of bilateral total hip arthroplasties (THA) several years ago presents with left hip pain after a fall. He was walking downstairs and slipped, twisting his leg internally and with adduction and flexion of the hip to catch himself. He denies falling but felt an immediate pop in his left hip and could no longer bear weight.
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Hip, Hip, Hooray!
September 28, 2022
I Kneed a Doctor
A 46-year-old female with a history of diabetes and morbid obesity presents with difficulty walking after tripping on a curb and falling onto her right knee.
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I Kneed a Doctor
September 21, 2022
Let the Feet Drop
A 20-year-old male distance runner who was jogging and happened to be running past the emergency department presents with severe bilateral leg pain, foot pain and foot numbness that resolved by the time he was evaluated in the ED.
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Let the Feet Drop
September 14, 2022
Back Gone Out but Won’t Back Down
A 16-year-old male basketball, football, and soccer player presents with persistence of low back pain that began acutely 5-6 weeks ago during weight-lifting when he felt a sharp pain in his right lower back mid-descent in a squat.
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Back Gone Out but Won’t Back Down
September 07, 2022
Use the Fascia
A 91 year old female presents with right hip pain after a fall. She denies head strike and is hemodynamically stable with pulses and sensation intact.
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Use the Fascia
August 31, 2022
You Walked on THAT?
A 79 year old female presents for left hip pain. She reports she fell a month ago and felt the pain but has since been able to walk, though she needs a walker which she did not use before. The pain has not improved so she came to the emergency department. She has pain radiating to the groin on palpation of the hip and with flexion of the hip joint.
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You Walked on THAT?
August 24, 2022
Pop Goes The Weasel
A 15-year-old male soccer player presents to the emergency department with right hip pain. He endorses the sudden onset of right hip pain which happened while he was attempting to kick a ball. He heard a pop at the time of injury and cannot ambulate without significant pain. Exam is notable for limited ROM with active hip flexion and tenderness over the anterior hip. Neurovascular exam is intact.
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Pop Goes The Weasel
August 17, 2022
Not Entirely Unhappy
Player in white with headband (Fig 1) is a 25 yo male patient who comes into the ED the day after sustaining the injury below. The patient is ambulatory with pronounced limp on arrival. Exam shows no joint effusion with significant medial joint line tenderness to palpation. Normal Lachman without laxity.
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Not Entirely Unhappy
August 10, 2022
Pop, Lock & Drop It
A 38-year-old female presents to the ED with right shoulder pain after a fall directly onto that shoulder. She noticed immediate pain and difficulty moving the arm associated with mild tingling in her right fingers.
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Pop, Lock & Drop It
August 03, 2022
The Hidden Post
A 23 year-old male presents to the emergency department with right ankle pain after he rolled his ankle while walking down the stairs. Ankle exam reveals ecchymosis over the posterior ankle and tenderness of the distal tibia. Neurovascular exam is intact.
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The Hidden Post
July 27, 2022
My Wrist Tried to Quit on Me
A 26 year old soccer player presents to the ED with ulnar sided wrist swelling and pain after sustaining a fall on an outstretched hand.
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My Wrist Tried to Quit on Me
July 20, 2022
Too Hot to Handle
A runner is brought to the medical tent of the local marathon after collapsing a few miles short of the finish line. He is conscious but confused and vomiting. It is a hot, humid day.
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Too Hot to Handle
July 13, 2022
Don’t be so Callus
Patient is a 45 year old male presenting to the ED with ankle pain. He states he fell one month ago and has been having significant pain since.
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Don’t be so Callus