SplintER Series: Delayed pain in an injured knee

pellegrini-stieda

Image 1. Case courtesy of Radswiki, Radiopaedia.org

A 26 year-old male presents with new medial right knee pain after twisting his knee playing soccer 3 weeks ago. His initial pain has since resolved.

What is your diagnosis? What examination findings should you expect? What associated diagnoses should you assess for? What is your management in the emergency department?

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Diagnose on Sight: Post-traumatic Finger Pain

acute osteomyelitis Case: A 32-year-old male with a past medical history of diabetes presents with a 1 month history of finger pain after slamming his finger in a car door. 2 weeks after the initial incident he presented to the emergency department for worsening pain and received x-rays that were negative for acute fracture. Today he presents reporting pain radiating up the hand, arm, and into the shoulder, with associated chills. His labs are significant for hyperglycemia, hyponatremia, and an elevated erythrocyte sedimentation rate and c-reactive protein. His x-ray is seen here (figure 1 image courtesy of Daniel Rogan, MD). What is the diagnosis?

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EMRad: Can’t Miss Adult Ankle and Foot Injuries

Have you ever been working at 3am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. We’ve already covered the elbow and wrist. Now: the foot and ankle.

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By |2020-03-04T09:26:41-08:00Mar 4, 2020|Orthopedic, Radiology, Trauma|

EMRad: Approach to the Traumatic Foot X-ray

Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships [1].​​ Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EM:Rad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the elbow, wrist, and ankle: now, the foot x-ray.

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By |2020-03-05T09:23:45-08:00Feb 26, 2020|Orthopedic, Radiology, Trauma|

EMRad: Radiologic Approach to the Traumatic Ankle

AP ankle radiographRadiology teaching during medical school is variable, ranging from informal teaching to required clerkships [1].​​ Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EM:Rad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the elbow and wrist. Now: the ankle.

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By |2020-03-05T09:20:55-08:00Feb 24, 2020|Orthopedic, Radiology, Trauma|

SplintER: Knee pain after the jump

tibial tubercle fracturesA 15 year-old male presents to the emergency department with left knee pain and swelling after jumping while attempting to dunk a basketball. You obtain a knee x-ray (image 1 courtesy of Mark Hopkins, MD). What is your diagnosis? What patient population is at risk for this injury? What other injuries occur in this anatomical location? What is your emergency department management?

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SplintER Series: Two cases of shoulder pain

 

Two patients present to your emergency department: Patient 1 is a 17 year-old soccer player who fell during a game onto their right side and is now complaining of mild right shoulder pain. You obtain x-rays (Figure 1). Patient 2 is a 21 year-old motorist who lost control and went over the handlebars. They heard a pop and are complaining of left shoulder pain. You obtain shoulder x-rays (Figure 2). For these cases, what are your diagnoses, expected physical examination findings, and emergency department management?

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By |2020-02-04T19:13:23-08:00Feb 5, 2020|Emergency Medicine, Orthopedic, SplintER|