A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
We’ve all been told to x-ray above and below the area in question. How much we do it varies, but we have all done it at one point, and rarely do I find an abnormality that was occult. Here we question when we can do less in a couple of orthopedic-specific issues.
Jose Reyes, MD
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Figure 1: Ultrasound of the bilateral Achilles tendon with notable findings of surrounding anechoic fluid collection (white arrow) and decreased tendon diameter of the affected side.
The Case:
A 32-year-old man with no past medical history presented to the ED with left posterior ankle pain after playing basketball. He stated he jumped and felt an immediate “pop” and pain in the posterior leg. He has been unable to ambulate due to the pain. On exam, he had a positive Thompson test on the left calf. Radiographs were negative for acute fracture, but point of care ultrasound (POCUS) demonstrated an Achilles tendon injury.
Megan Buranosky MD, Victoria Gonzalez MD, and Scott Sherman MD
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A 43-year-old otherwise healthy man presented to the ED with ankle pain and swelling. Patient was playing basketball 5 days ago and twisted his left ankle. He initially presented to an outside hospital where he was told he had an “ankle” fracture and was splinted with a short leg posterior splint. He presented to our ED for worsening pain and swelling of his lower leg. On exam, the patient has ecchymosis and edema of the ankle extending proximally just inferior to the knee. There was pain with tibio-fibular compression and point tenderness was present over the medial malleolus and proximal fibula with overlying ecchymosis. The compartments were soft and the leg was neurovascularly intact. The patient was sent for radiographs.
Maria Gomez, MD
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