Sternoclavicular Joint Dislocations: Diagnosis and Treatment

Image obtained from healio.com

A 16-year-old football player presents to the emergency department directly from a game. He was tackled, falling onto his right shoulder. The patient is complaining of right-sided chest pain. On exam, there is tenderness over the right sternoclavicular joint (SCJ) with a prominent medial clavicle. Range of motion is limited in the right arm. What diagnostic studies need to be performed? What treatment is warranted in the emergency department?

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By |2019-02-06T20:11:22-08:00Jul 21, 2014|Orthopedic|

High risk back pain: Cauda Equina Syndrome (EREM)

cauda-equ-disc11Cauda equina syndrome (CES), which occurs due to compression of the distal lumbar and sacral nerve roots, is a potentially devastating cause of back pain. CES is often missed on the patient’s initial visit which can lead to  significant neurologic compromise in a matter of hours [1]. To improve patient outcomes and minimize medicolegal risk, providers need to understand the limitations of the history and physical and carefully consider the diagnosis of CES in any patient with back pain.

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By |2016-12-20T11:19:57-08:00Jun 9, 2014|Medicolegal, Orthopedic|

52 Articles in 52 Weeks: Landmark EM Articles 2013

52To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.

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Quick clinical tip: Rotational angulation of metacarpal fracture

Metacarpal Fx x2sm

Metacarpal fractures are commonly present to the Emergency Department for care. The plain film shown here shows metacarpal neck fractures of the middle and ring finger shown. There are specific criteria requiring closed reduction in the ED (PV Card). Generally ANY rotational angulation requires reduction. Detection of such angulation depends on the clinical exam rather than the plain film. How does one diagnose it?

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By |2016-11-11T19:03:49-08:00Sep 19, 2013|Orthopedic|

Quick clinical tip: Elson’s test for the finger

Extensor Tendon Laceration Finger 6 smInjuries to the hand are fraught with multiple, concurrent injuries. Many injuries may have chronic debilitating complications, if not detected early. One such example is a finger laceration with a concurrent extensor tendon injury, causing delayed boutonniere deformity formation and limited function. Review the anatomy of the extensor tendon. View the video on how to perform the Elson’s test to detect a central slip tendon injury.

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By |2020-12-27T19:00:43-08:00Jul 29, 2013|Orthopedic|
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