Ortho EM Pearls

Tolerate More Than Pain

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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Splinting Series

April 10, 2024

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).

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.

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.

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.

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.

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.

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.

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.

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:

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.

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.

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.

January 27, 2024

Finger/Digit

A 25 year old female is complaining of thumb pain after falling during a ski run. You obtain a longitudinal image of the ulnar thumb in normal and stress views with the following findings.

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.

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.

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.

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.

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.

December 23, 2023

Anterior Hip

A 76-year-old female fell from standing onto her left side. She is complaining of left hip pain.

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We are excited to begin this journey with you. There are TONS of excellent resources out there, but the purpose of our website is to provide you a consistent dose of high-yield image-based MSK cases so you can take something with you to your next shift in the Emergency Department!

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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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