EMRad: Can’t Miss Adult Knee Injuries

knee radiology

Figure 1: Normal AP knee x-ray. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, annotations by Stephen Villa MD.

Have you ever been working a shift 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. Now: the knee.

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By |2020-06-24T07:43:05-07:00Jun 29, 2020|EMRad, Orthopedic, Radiology, Trauma|

Trick of the Trade: Windex for Ring Removal

A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4th-5th metacarpals, with mild swelling extending to the 4th-5th digits. The patient also notes that he slightly deformed his wedding ring during the fight and he has since been unable to remove it. It’s a busy overnight and the patient has been in the waiting room for an hour. While waiting nursing staff had the patient ice his hand while elevated and attempted to remove the ring with a water-based lubricant. All attempts to remove the ring thus far have been unsuccessful.

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By |2020-06-16T09:21:38-07:00Jun 16, 2020|Orthopedic, Tricks of the Trade|

EMRad: Can’t Miss Adult Shoulder Injuries

AP view shoulder

Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their primary doctor 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 aims to highlight and improve your sensitivity for these potentially catastrophic injuries. Now: the shoulder

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By |2020-05-14T22:35:01-07:00May 6, 2020|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Radiologic Approach to the Traumatic Shoulder

Normal-shoulder series

This is EMRad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department [1]. When applicable, it will provide pertinent measurements specific  to management, and offer a framework for when to get an additional view, if appropriate. We have already covered the elbow, the wrist, and the foot and ankle. Next up: the shoulder.

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By |2020-05-14T22:35:10-07:00May 6, 2020|EMRad, Orthopedic, Radiology, Trauma|

A Pop in the Calf – Plantaris Rupture

plantaris rupture

A 32 year-old male presents to the Emergency Department after he felt a “pop” in his posterior-medial calf while playing tennis. He was able to ambulate but had pain with plantar flexion and was unable to continue playing tennis. What is your differential diagnosis? What physical exam maneuver would you perform? What findings would you expect on physical exam? What is the diagnosis based on ultrasound images? What is your management in the emergency department?

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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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