Case presentation An 18-month-old female presents with 1 to 2 weeks of fussiness and not wanting to ambulate. She has not had any fevers, vomiting, or diarrhea. There is no report of trauma. About 2 weeks prior, she had a cough, congestion, and low-grade fever (100.4 degrees Fahrenheit) that resolved after a few days. She has been healthy since then. Her primary care physician evaluated the…
Case presentation A 2-year-old female is brought for evaluation for right leg pain. The child was jumping in a trampoline house and fell on her right leg. The parents, who accompany the child, did not witness the mechanism by which the child injured her leg, but they state that the child was on the trampoline with several other children, the oldest of whom is 9 years…
Case presentation A 4-year-old female presents with 1 week of left-sided abdominal and hip pain. She was evaluated at an outside facility 5 days ago, had plain abdominal radiography, and was diagnosed with constipation. She then returned 2 days later with continued fever but was noted to have difficulty ambulating and reported generalized back pain. She had a urinalysis done that was reportedly concerning for a…
Case presentation A 13-year-old male is referred to the Emergency Department by his primary care provider. The patient has had left hip pain for the past week, which has progressively interfered with his daily activities, such as sports, and now has made ambulation difficult. He has had subjective fever but no recent illness and denies any trauma. There has been no back pain, abdominal pain, incontinence,…
Case presentation A 14-month-old previously healthy male presents with limping for the past 5 days. Prior to this symptom, he had cough, congestion, and subjective fever, which his primary care provider had diagnosed as a viral upper respiratory infection. He appeared to be improving when he developed a left-sided limp, which appeared at times to be painful, although over-the-counter ibuprofen seemed to help with pain. On…
Case presentation A 15-year-old male presents to the Emergency Department with a complaint of “severe headaches” for the past week. He states he has had cough, which is worse at night, and congestion for the past 2 weeks. He has had minimal rhinorrhea that was initially clear, then green, and is now clear again. He initially had a temperature of 101 degrees Fahrenheit, but this resolved…
Case presentation A previously healthy 14-year-old male presents with left lower quadrant pain, difficulty bearing weight, and fever. He awoke 6 days ago with sharp left lower quadrant pain. At that time, he was seen at an Emergency Department where abdominal computed tomography (CT) and bloodwork were obtained, which were reported to be normal. He was diagnosed with abdominal wall strain and was discharged home with…
Case presentation A 15-year-female presents with low back pain for 2 months. She had no trauma preceding the pain but is very active and plays soccer. The pain increases with activity. She has tried ibuprofen multiple times, with some relief. Her mother took her to her primary care provider last week where a urine test was performed, which was unremarkable. She has not had fever, vomiting,…
Case presentation A 14-year-old male is brought to the Emergency Department after being involved in a motor vehicle crash. The patient was a restrained front seat passenger in a vehicle that was struck by another car while stopped at a red light. The patient did not lose consciousness and has no complaint of head pain, neck pain, back pain, or abdominal pain. He states he feels…
Case presentation A 12-year-old male presents to the emergency department with left ankle pain. Two hours ago, he was jumping on a trampoline when he “landed wrong, twisting” the ankle. He cannot remember in which direction the ankle twisted but he states he developed swelling to the ankle and had difficulty ambulating due to pain. He denies neck pain, back pain, numbness, and weakness, and there…
Case presentation A 7-year-old male is brought in for evaluation. A few hours prior to presentation, he was jumping up and down on a couch when he jumped off, landing on his right leg. He states he heard a “pop” and then began to experience pain and difficulty with ambulation secondary to the pain. There is no reported loss of consciousness; he denies neck pain, back…
Case presentation A 14-year-old female is brought to the Emergency Department following a basketball game. She pivoted to take a shot and felt a tearing sensation, followed by a pop, then fell to the ground. She presents with an obvious right knee deformity. Her vital signs are normal for her age, and on examination, her knee is held in flexion at 30 degrees with a laterally…
Case presentation A 9-year-old female presents with 5 weeks of progressively worsening left knee pain. There has been no known trauma and the family denies fever, rash, knee swelling or erythema, weakness, numbness, or incontinence. She is able to ambulate but, due to her pain, has been excused from physical education classes at school. She has seen numerous physicians, and multiple plain radiographs of the left…
Case presentation A 2-year-old male presents with acute right leg pain after falling while jumping on a trampoline. Apparently, he fell off the trampoline onto the ground and landed on his left leg. The distance was estimated at 3 ft (approximately 1 m) and the incident was witnessed by his parents and two older siblings. There is no reported loss of consciousness. The child is unable…
Case 1 presentation A 14-year-old male presents with a complaint of acute right hip pain. The patient is an avid soccer player and was kicking a ball “pretty hard.” Immediately upon full extension of the right leg, he felt a “pop.” Thereafter, he began to experience pain that was radiating to the right upper thigh. He was unable to continue the game. He denies other injury…
Case presentation A 12-year-old male presents with a left fifth phalanx injury (his “pinky” finger). He was jumping on a trampoline and somehow injured the digit; he believes he landed on the digit. Since then, he has had pain and swelling. His examination reveals a patient complaining of digit pain. There is swelling and tenderness of the left fifth digit at the proximal interphalangeal (PIP) joint…
Case presentation A 15-year-old male presents with left hand pain after becoming angry and punching a wall. He did this several hours ago and his only complaint is medial hand pain; he denies digit, wrist, forearm, or elbow pain. He denies numbness or weakness. This is the second time he has sustained this injury. However, he was not seen the first time because he and his…
Case presentation A 16-year-old female presents to the emergency department with complaints of right wrist and hand pain following a fall on an outstretched hand during sports practice after school. Vital signs are age appropriate and her physical examination is significant for tenderness in the anatomic snuffbox and the radial portion of the wrist. Grip strength and range of motion in the wrist are both reduced…
Case presentation An 11-year-old male presents with left wrist pain and swelling 3 days after he fell while playing soccer. Apparently, in the course of the game, he fell on his outstretched left arm. After the injury, he continued to play but later in the day he noted pain and swelling to the left wrist. He denies neck, shoulder, elbow, upper arm, hand, or digit pain.…
Case presentation A 4-year-old male presents with right forearm pain after falling while in a “bouncy house.” Apparently, the child was in the house with several other children and had a witnessed fall onto the arm. The parents noted that he had swelling to his right elbow. There is no other reported injury, and Emergency Medical Services applied a temporary splint and gave the child intranasal…