Paperclips: Lever Sign

We really should not be behave like an old school knee exam with a conventional X-Ray is worth what the charge is for a visit to a standard hospital-based ER. Likely this will amount to WELL over one-thousand dollars for the visit--and once completed, they are no better off than knowing, "my knee is injured".

While this is another in long long parade of bedside orthopedic exams for injury identification, for which there seems to be no limit for the eponym torture (everyone gets their name on another poor sensitivity/specificity exam tactic), it still skips the essential issue: they need to know what is injured, and the degree of injury, in order to develop a coherent plan. Yes, I will use this new clinical technique in my practice. But we should re-think how we manage knee injuries in the ER--and it is not the way we do it in current practice--exam, X-Ray, bye bye.

When we do an exam and an X-Ray, and then kick it down the road to the PCM to order the MRI, we aren't helping anyone but for our hospital CFO. It takes weeks or longer to actually get to orthopedics and physical therapy that way. We need to get the ball rolling sooner. We need to sort out some simple criteria for in-ER MRI for knee injuries. The MRI is what determines the plan ultimately. Otherwise, we are saying that throughput is the ultimate priority-- that plus a marginally-helpful evaluation for a lot of money. That is a sham. This exam tidbit is not a sham. It is helpful, somewhat. But it had a lot more value in 1950, or heck 1750 for that matter--when we didn't have the actual means to literally see the injury. But we do now--and have for some time. Why do we keep doing it this way though?