July 2022: Locked

​"Can you order this guy some pain medicine?" the nurse asked me. “He looks like he's in agony."He had tipped over while standing on top of a step stool. Now he couldn't straighten his knee. It was unyieldingly bent at 90 degrees, and any attempts to extend it met with resistance.The presentation seemed classic. I had seen this once before; it had to be a bucket handle meniscus tear. We would get a precautionary x-ray, but I was already explaining how a bucket handle tear was analogous to a rug being stuck under a door. I asked him to imagine how hard that makes it to move the door. The same thing was happening to him with a tear in the soft tissue heaping up on itself, essentially locking the knee in flexion. I put 15 mL of bupivacaine in the joint to numb and hopefully widen it a little to let the joint flatten out.It didn't.Fortunately, the orthopedist on call was around and saw him immediately. His first question to me was whether I went into the joint. I did, I told him, and there was free flow. His second thought was that maybe there wasn't enough fluid. He repeated the injection and tried to wiggle the knee to coax it into extending.It was a no-go for complete extension and pain relief, but enough to get an MRI to prove what we believed before taking him to arthroscopic surgery. It was the first time I had ever ordered a knee MRI, and it was classic! A normal meniscus looks like a bowtie, but that was absent in our patient.​A double delta sign, whi...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs