When You Hear Hoof Beats, Think Zebras? An Unusual Case Of Low Back Pain In An Adolescent Athlete. - Page #1

Author: Amanda Goodale, DO
Co Author #1: Richard Okragly, M.D.
Editor: Joseph Chorley, MD

Patient Presentation:
13 year old female softball player presented with non-traumatic low back pain.

Patient presented with low back pain that started two weeks prior to presentation. There was no associated injury. Pain was of gradual onset and described as mild, dull, and achy. She denied fevers, chills, nausea, emesis, paresthesias, radiating pain, saddle anesthesias or prior injury. She was initially evaluated in the emergency room following a softball game. X-rays were read as normal and she was diagnosed with lumbar strain. After multiple follow up visits with her primary care physician, the pain failed to improve despite the use of multiple anti-inflammatories (ibuprofen, meloxicam, naproxen) as well as cyclobenzaprine, home exercise program and one month of regular physical therapy visits.

Physical Exam:
Vital signs were all within normal range. She was in no acute distress and well-appearing. Inspection of the spine revealed no evidence of deformity, ecchymosis, swelling or skin lesions. She had full range of motion with side bending, axial rotation, flexion and extension. Pain was slightly increased with spinal flexion. Tenderness was noted at the lumbar paraspinals, right greater than left. There was no midline tenderness. She had full strength in all muscle groups of the upper and lower extremities. Patient was able to heel and toe-walk without difficulty. Straight leg raise, stork test and FABERs testing was negative bilaterally. Patellar and Achilles DTRs were 2+ bilaterally. She demonstrated normal balance and coordination. Sensation was intact and equal along all dermatomes. No focal neurological deficits were identified.

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