It’s That Time of Year

February 2, 2016

Seasons in the radiology department.

Just in case you have been living under a proverbial rock the past few weeks, you may have neglected to notice that a good portion of the Eastern seaboard which accounts for about 20% of the U.S. population, just withstood a major winter storm. Snowfall totals included: Washington D.C.: 28 inches; Philadelphia: 23 inches; and New York City: 27 inches. According to weather service records it was either the third or fourth biggest snowstorm, since records were kept.

The brunt of the storm struck on a Saturday, and (thank God!), I wasn’t on call. If I had been, there would have been no way I would have been able to drive in the near total whiteout that was happening during the day on Saturday, and therefore I would have been sleeping on a gurney in one of the ultrasound exam rooms in the hospital. Nevertheless, my first day back to work was Monday, following the massive snow dump. As I began to go through the caseload from the weekend, I came upon a routine X-ray of the left hand request from the ER. The history stated: “snow blower accident.” As one could guess, before even looking at the study, there were traumatic amputations of the distal second, third, and fourth digits.

I shuddered as I went about dictating the case, imagining how the accident might have happened: “hmmm clogged snow blower, let me shut it down, and then I can stick my hand in the intake and unclog it…AARRRGGHHH!!” Well, maybe the person didn’t exactly use that exact expletive, but you get the point. I felt very lucky, as it was only a couple days ago that I borrowed my neighbor’s snow blower (which I had never used before), to clear the 23 inches of snow from my driveway.[[{"type":"media","view_mode":"media_crop","fid":"45519","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9436100804870","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5215","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 181px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©bilha golan/Shutterstock.com","typeof":"foaf:Image"}}]]

I finished dictating the case and began to think of all the seasonal-type injuries that we, as radiologists, are accustomed to seeing. As I mentioned, during the winter, besides seeing amputated fingers from snow blower accidents, you see a fair share of fractured ankles from ice skating, skiing, and snowboarding. Nuclear cardiac stress tests for the invariable “chest pain while shoveling snow;” MRI’s with ACL tears from skiing, and the innumerable fractured hips, elbows, wrists, and ankles from “slipped and fell on ice.”

Assuming you survive the numerous hazards of winter, the coming of spring and the warm weather brings a whole other host of outdoor related injuries to the EDs of hospitals. We have all seen the “hit in the orbit with a baseball” and the Achilles tendinopathy from “overuse running injury.” What about the fractured pelvis from “horseback riding injury,” or the dislocated shoulder from the overzealous weekend mountain biker?

Ultimately, summer comes; my favorite time of the year. Being cooped up inside for months, children emerge from school classrooms and adults awaken from winter hibernation. It’s time to go to the shore for the weekends! But, don’t go diving head first in the shallow water, or you might end up with a cervical spine fracture, requiring a MRI. Or, what about the subdural hemorrhage the 75-year-old man sustains from “fall from ladder while fixing the roof.” How about the severed forefoot seen on a foot X-ray from the drunken guy with a chief complaint of, “lawnmower accident while wearing flip flops?” This pales in comparison to the MRI elbow for “golfer’s elbow.”

Reading all of these different seasonal related injuries, one would think that the practice of radiology has worked out some sort of deal with mother nature, in order for her to continuously supply us with imaging studies to interpret. So, the next time it snows, and I sure hope we are done for the season, and you are at work reading cases, and you come upon that lumbar spine X-ray request that says, “slipped and fell on ice; back pain.” Think to yourself, it’s that time of the year again!