Author: Kristen Lafferty, DO
Co Author #1: Jason Diehl, MD
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Ian McKeag, MD, MS

Patient Presentation:
A 21 year old female collegiate soccer and lacrosse player presented to her athletic trainer for low back pain after sustaining a direct blow to her lower back during practice and was held from further participation that evening. The following day she presented to the training room with the complaint of an uncontrollable shaking left leg and resolution of her back pain. Upon presentation to the medical staff she also complained of left lower extremity weakness which led to difficulty walking. She had been in her usual state of health and stated she had no recent illnesses.

History:
She reported no significant past medical history. She denied numbness, tingling, saddle anesthesia or difficulty with bowel or bladder control. No systemic signs of illness such as fevers, chills, unexpected weight loss, night time awakenings or night time pain were reported. She denied any visual changes or visual disturbances, headaches, respiratory or gastrointestinal symptoms.

Physical Exam:
General: no acute distress
General: no acute distress
Spine: no deformities, or hematomas. No tenderness to palpation over spinous or transverse processes. Bilateral lumbar paraspinals exhibit hypertonicity. Range of motion within normal limits.
RLE: Range of motion full. 5/5 muscle strength in hip, knee and ankle. Sensation grossly intact.
LLE: Visible fasciculations of her left lower extremity noted at rest, most prominent in her quadricep muscle group. No hematomas, lacerations or contusions appreciated. No tenderness to palpation along quadriceps muscles or over insertion site at the anterior pelvis. Range of motion is full and non-painful, however fasciculations worsen with hip flexion. Muscle strength with hip flexion is 4/5, as well as plantarflexion of the foot. Remaining muscle groups of the left lower extremity exhibit 5/5 muscle strength. Sensation is grossly intact.
Neuro: Bilateral patellar and achilles reflexes 2+/5.
Vascular: 3+ dorsalis pedis and posterior tibial pulses bilaterally

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