The Case:
25 year old man with no past medical history presents to the ED with acute left shoulder pain. He was playing soccer, jumped up for a header, and fell onto his left side 1 hour ago. On exam, his left upper extremity is adducted, internally rotated, and flexed at the elbow. He is neurovascularly intact, and range of motion is significantly limited secondary to pain. He otherwise has no obvious humerus deformity and no pain with palpation of humerus, elbow, forearm or wrist. You suspect a shoulder dislocation. Radiology is called to conduct bedside x-ray prior to reduction. However, they are busy in trauma with a multi-victim motor vehicle accident and say it may take up to 1 hour to obtain x-rays given they are short staffed today. So, you reach for your ultrasound…
Ramin Chitsaz, MD
Read MoreThe Case:
A 42-year-old right hand dominant male with no known past medical history presents with pain in his right thumb. He works as a painter and was using an industrial paint sprayer when he injected a water-based paint into his right distal thumb pad. He states he had significant pain initially, but it quickly settled to a dull throbbing. He waited five days from the injury to visit his primary care doctor who instructed him to come directly to the ED. His vital signs are within normal limits. There is a small punctate wound on the volar surface of the distal right thumb that is mildly tender to palpation without surrounding erythema, swelling, or drainage. There is no tenderness more proximally. Compartments of the hand and forearm are soft and compressible. The digit is neurovascularly intact excluding an area of decreased sensation at the tip of the thumb. X-ray of the right hand and thumb are shown below.
Adam Roussas, MD
Read MoreThe Case:
A 40-year-old male with no past medical history presented to the emergency department after he was assaulted with closed fists just prior to arrival. The patient’s injuries included a blow to the back of his right hand. On exam he was found to have swelling and tenderness to the dorsal aspect of his right hand. He had brisk capillary refill and normal sensation to light touch in all fingers. There was no malrotation of fingers with a closed fist.
Matthew Hughes, MD
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