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Allowing Space For Healing: Atraumatic Back Pain In A Healthy Adolescent - Page #1
 

Author: Jean Valette, MD
Co Author #1: Jean Pierre E. Valette, MD
Co Author #2: Sarah Merrill, MD
Senior Editor: Larry Nolan, DO
Editor: Marc Hilgers, MD, PhD, FAMSSM

Patient Presentation:
11 year old male with no past medical history complained of sudden onset severe bilateral low back pain upon awakening 4 days prior to presentation.

History:
The patient participated in physical education class the day prior, but denied any trauma or injury. His discomfort progressed rapidly from soreness to intense pain with simple ambulation. He also developed pain radiating down the left posterior leg and right anterior groin. Patient denied numbness, tingling or weakness of lower extremities. No difficulty walking, groin anesthesia, or bowel or bladder dysfunction. Mother had been treating with ibuprofen with minimal relief of symptoms. Of note, patient was sick with fever to 102˚F and URI symptoms 1 month prior. Further ROS was negative.

Physical Exam:
Neuro: CN II-XII intact, 5/5 strength in upper extremities and lower extremities bilaterally, sensation grossly intact in all four extremities, negative Brudinski and Kernigs tests.

Back: Decreased ROM flexion and extension. No midline TTP, positive TTP bilateral L-spine paraspinals and SI joints. full ROM upper extremity and lower extremities, Negative straight leg raise, positive tight posterior cords bilaterally, Negative slump test, Positive stork test bilaterally, Negative femoral nerve stretch.

Hips: No TTP, Full ROM bilaterally, 5/5 strength in all muscle groups, No pain with axial loading. Negative FABER, Negative FADIR, No pain with with flexion, abduction and internal rotation.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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