Uncommon Cause Of Back Pain In A Cyclist - Page #1

Author: Katherine Guran, MD
Co Author #1: Tallat Rizk, MD

Patient Presentation:
A 56 year-old male cyclist presented to the clinic with significant pain in his right groin radiating to his lower back and right hip.

For the past 20 years, the patient has ridden a bicycle for two hours per day, with no recent change in activity or injury. He began to develop his pain about two months prior to presenting and it was getting gradually worse. He was initially seen by his primary care physician who ordered a lumbar MRI, which showed mild disc disease. He then received an epidural injection by Pain Management, which did not provide relief. He was then seen by Orthopedics who ordered a hip MRI, which showed mild osteoarthritis. Accordingly, he underwent an intra-articular hip injection, which also provided no relief. Despite these treatments he continued to have increasing lower back pain, as well as groin and right hip pain, which affected his ability to ride, walk, or sleep comfortably.

Physical Exam:
Vital signs were within normal limits. Patient is a well-developed, well-nourished male. He had mild tenderness to palpation of lumbar paraspinal muscles especially around L5. He had no tenderness to palpation of his bilateral SI joints. He had moderate tenderness to palpation over his symphysis pubis. Neurovascular exam was normal. Reflexes were equal and symmetric. Strength was 5/5 throughout bilateral lower extremities. Straight leg test was negative bilaterally. Patrick’s test was positive on the right, negative on the left.

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