An Extreme Case Of Sibling Rivalry

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An Extreme Case Of Sibling Rivalry - Page #1

Author: Joseph Friedli, MD Co Author #1: James L. Moeller, MD, FAMSSM Senior Editor: Justin Mark Young, MD Editor: Elizabeth Williams, DO Patient Presentation: A 16-year-old female soccer player with no past medical history presented for evaluation of six months of low back pain. History: She initially had concern for pain on her right side but then subsequently developed left-sided discomfort with extension and rotational movements. She denied suffering a specific injury and had taken herself out of soccer activities. Pain worsened with running and physical activity and was relieved with rest. She denied radicular symptoms, numbness, tingling, fevers, or urinary retention. Coincidentally, her older brother presented to the same office at the same age with a similar history, three years prior. Physical Exam: 16-year-old female presented in no acute distress with normal gait. She had pain and limited range of motion with spine extension and rotation. On palpation, exam revealed tenderness to palpation at left L3-L5 paravertebral muscles. She was noted to have a positive Stork test bilaterally causing left-sided discomfort; positive right Trendelenberg sign. Her bilateral lower extremity neurological exam revealed 2+ Patella and Achilles deep tendon reflexes; 5/5 strength in hip flexion, knee flexion/extension and ankle dorsiflexion/plantarflexion. Her sensation was intact to light touch in all bilateral dermatomes. Review of her brother's physical examination from three years prior showed similar findings. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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