Quadriceps tendon rupture. Xray or not?

The quadriceps tendon attaches the quadriceps muscle to the patella. Tears most often occur just above the insertion on the patella. They more commonly occur in men (8:1 ratio) and patients report hearing a popping sensation doing activities that involve a change of direction while jumping or landing from a jump. Diagnosis can often beRead more

The Fascia Iliaca compartment block: as magical as it sounds!

In case you haven’t gotten to this month’s EM:RAP, there’s a really great segment on an important ED procedure that we definitely don’t do enough of in the ED: the nerve block. The section discusses the femoral nerve block and how to perform a fascia iliaca compartment block (the “3-in-1” block)–which hits 3 major nervesRead more

Reduction technique for Nursemaid’s elbow

It’s another busy afternoon in the peds ED when grandma comes in stating that her grandson broke his arm. He was jumping on the bed, and reached out to grab hold of a side rail before falling to the ground. It looks normal, but now the little guy refuses to use the arm and isRead more

Hyperpronation for Nursemaid’s elbow reduction

“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.” -Kailash Satyarthi   Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not useRead more

Tricky Orthopedics

That being said, let’s go through some commonly tested and easily confused orthopedic entities… Salter-Harris Classification Type 1 – Slipped (Physis) Type 2 – Above (metaphysis) Type 3 – Lower (Epiphysis) Type 4 – Transverse all 3 Type 5 – Rammed (crush) Hand/Wrist injuries Scapholunate vs. Perilunate vs. Lunate Dislocation Mechanism for all 3:Read more

Ouch! My thumb!

A 44M with no PMH slipped and fell on his hand while playing with his kids in the park. He has swelling and pain over thumb MCP joint that is exacerbated by movement. The xray of his thumb is above, what is your diagnosis? This injury is known as skier’s thumb. The mechanism is aRead more

Lunate and Perilunate dislocation

A 36F presenting with wrist pain after a fall on an outstretched hand. She has pain and swelling over the dorsal-radial aspect of her hand. Her xray is below, what is the diagnosis? It’s the spilled tea cup sign, but can you remember which dislocation it stands for?? It is the lunate dislocation. Both theRead more

Compartment Syndrome: UNDER PRESSURE

Dr. David Forsh’s review yesterday of compartment syndrome made me realize how rarely we see this life-threatening diagnosis. So what do we need to know? What’s the etiology of compartment syndrome? Majority cases 2/2 Fractures (75%); the rest are soft tissue injuries from causes such as: snake bites, seizures, burns, tourniquets,… People with coagulopathy suchRead more

Unstable Cervical Fractures

Last pearl before our inservice tomorrow. Good luck to everyone. Hopefully this will buy you an additional point.   Jefferson Bit Off A Hangman’s Tit = Unstable cervical spine fractures   Jefferson Fracture A burst fracture of the ring of C1 Typically caused by an axial loading force to the occiput (think diving injury) TypicallyRead more

Knee Immobilizer Pearl

53 yo F was walking in high-heeled boots on the cobblestones of the west village. She slipped and suffered a knee twisting injury. On exam, she has an effusion but her plain film is negative for fracture/dislocation. She is in too much pain to bear weight but there is no appreciable laxity in the kneeRead more