The Case:
A 56-year-old male with no significant past medical history presents to the emergency department with worsening swelling, pain, and erythema of the right elbow. The patient had been seen two days earlier at an outside hospital, where he received an aspiration of his right elbow out of concern for septic arthritis, though the aspirated fluid demonstrated no organisms. He was thereafter discharged home with oral antibiotics. However, he continued to have worsening range of motion of the right elbow due to pain and swelling, though he is still able to pronate and supinate his arm. He also states that the erythema of his right elbow has increased in size and tracked proximally since being seen at the outside hospital two days prior.
Michael Dorritie, DO
Read MoreThe Case:
A 15-year-old presented with right index finger pain. He states he was catching a football and it hit the tip of his right index finger and forcibly flexed it causing pain at his DIP joint. He was initially seen in triage and right hand radiographs were obtained and read by the radiology resident as negative (Figure 1). On examination, the patient had tenderness over the dorsal aspect of the DIP joint with weak extension. Based on the exam and suspicion of a fracture seen on the hand radiographs, the patient was sent back to get dedicated radiographs of the involved digit (Figure 2). Soon after, the radiologist called to report an intra-articular Mallet fracture. The patient’s DIP joint was splinted in extension and sent for orthopedic follow-up.
Scott Sherman, MD
Read MoreThe 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
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