A 36-year-old female was working on her deck 2 hours ago whe…

A 36-year-old female was working on her deck 2 hours ago when her thumb got caught between two planks of wood. She is reporting severe persistent pain in the left thumb nail and states it seems to be getting worse. On exam the patient’s thumb nail has black/purplish discoloration underneath the intact nail. She maintains normal AROM, and is neurovascularly intact. There is a XR negative for fracture. Based on her exam, what is your diagnosis and what would you recommend? 

A 28 year old patient presents to the clinic with acute pain…

A 28 year old patient presents to the clinic with acute pain to their lateral ankle following a misstep while hiking on uneven terrain causing internal rotation of the ankle. She reports immediate onset of pain, swelling, and difficulty bearing weight on the affected ankle. On physical exam she has bone tenderness over the lateral malleolus on the right ankle.  She is able to take 4-5 steps in the exam room today on the affected ankle. According to the Ottawa Ankle Rules, what is the next best action for this patient?