Interesting Mechanism Leads To An Uncommon Thoracic Injury - Page #1

Author: Gary Visser, MD
Co Author #1: Michele Pescasio, MD
Co Author #2: Adam Wait, DO
Co Author #3: Saif Usman, MD

Patient Presentation:
A 15 year old male football player presents to an orthopedic clinic for the evaluation of acute back pain.

The patient states the pain is located between his shoulder blades. He describes his pain as tightness with a dull ache, 4/10 in severity. No radiation of the pain. The pain is continuously present, worse with lifting heavy objects, improved with rest. No associated numbness, tingling, weakness, bowel or bladder incontinence. The pain started after he sustained a contact injury during his last football game 3 days ago. He remembers going to make a tackle, when the other player's knee hit him directly on the front of his head, forcing his neck into extension and causing an acute pain in his back Case Photo #1 . He was able to move all his extremities after the hit and was evaluated on the field with no complaints of any cervical spinous process tenderness, neurological symptoms, or pain with movement of his neck. Since the injury, he has not played any football or done any type of strenuous activity.

Review of systems include no loss of consciousness after the hit, no headache, dizziness, confusion, feeling of being in a fog, photophobia, nausea, or vomiting.

Physical Exam:
Vital Signs were stable. He is well developed with a BMI of 20, in no acute distress, and has a normal gait. His head is normocephalic, pupils are equal, round, and reactive to light. No deformity noted on inspection of his neck and back. No spinous process tenderness with palpation of the cervical, thoracic, and lumber spine. There is some tenderness with palpation over the paraspinous muscles between C7 and T1. His neck and back demonstrate full pain free range of motion. Negative Spurling's test and straight leg raise in the sitting and supine position. The rest of his exam including a complex neurological and extremity evaluation are normal.

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