Nailbed Lacs

A young man comes into your ED after slamming his right middle finger in the door. You see a large gash over the nail, and your hand specialist is not available to take care of the injury. What do you do? picture is from lacerationrepair.comRead more

Twisted Ankle

A 32 yo M presents with ankle pain and swelling after forcefully externally rotating it while playing soccer. He is unable to ambulate.  Ankle x ray is shown below. What other joint should you image?Read more

Name That Fracture

A BRead more

Spilled Teacup

A 28 yoM comes in with hand pain after falling on an outstretched hand. His xray is as follows.   What is the diagnosis?Read more

Physical Exam in Septic Arthritis

CASE: 40yoM no PMHX with a swollen, painful right hip joint.  Worsening x5 days. No history of prior episodes, no other joints involved, no fever, no trauma, no GU symptoms, no rash, no vision changes, no IVDU. On exam, pt is afebrile, nontoxic appearing. The hip is warm. You are able to range his hip,Read more

Ouch, My Back

34 yo M BIBA s/p fall from 3 stories, suicidal attempt. Pt is AO3, CTA b/l, pelvis stable, able to lift all extremities off stretcher, sensation and peripheral pulses intact. Pt has right lateral heel/ankle deformity. +step off L1-L2 area, good rectal tone. Red trauma was activated. CT shows compression fracture of L1 with loss of vertebral height ofRead more

Thumbs Up

A 25 year old rugby player presents with R thumb pain that began yesterday. She reports that she was trying to make a tackle and was stiff-armed. She fell to the ground, landing on an outstretched hand. Her pain is localized to the MCP joint, and she has some swelling and ecchymosis of the thenar eminence. She reports difficultyRead more

10 y F p/w right neck pain starting last night, she has decreased ROM with her head tilted to the left. atlanto-axial subluxation on CT This child has atlanto-axial subluxation, sometimes called Grisel syndrome. The key to identifying this condition and differentiating it from torticollis caused by muscle spasm is the relationship between head positionRead more

Sinai Em Pearl 04/11/2013

Oh bother *sigh* its Thursday April 11, 2013. Cloudy today 56 degrees with 30% chance of rain, going down to 44 degrees tonight with 60% chance of rain.      Let’s try to brighten up our day with another wonderful pearl by yours truly! 55 year old Caucasian male, presents with right shoulder pain after bicycleRead more

Painful, Swollen Great Toe

Case courtesy of Dr. Ngai. 57 year old man with a pmhx of CHF, afib on warfarin presents with a swollen and painful R great toe for the past 24 hours; this has never happened before; no fever, is otherwise well. So the question is obviously is this a crystalline arthritis (gout/pseudogout) or is itRead more