HPI: A right-handed, 17 year-old female high school varsity volleyball player present to the sports medicine clinic with acute onset of low back pain. Symptoms began approximately two weeks prior to presentation. Initially the pain began on the left side but now has moved to the right side. The pain is now only right-sided and it is worse with serving. The athlete experiences the back pain with movement of her right as well as her left leg. She states a history of low back pain in the past that had resolved. The back pain was treated with conservative measures and no radiographs or other ancillary studies were done at that time.
Currently, the athlete notes pain of 10/10 while playing volleyball. It will diminish to a 5/10 with sitting and other normal daily activities. She was placed in a back support that has helped relieve some of the low back pain. The athlete denies any numbness, tingling, paralysis, loss of bowel or bladder control. She is not aware of sustaining any specific trauma or injury to her back. The athlete has received a college scholarship to play volleyball beginning August 2006.
Medications: Daily Multivitamin, Vitamin E 400 I/U daily, Motrin 400 mg three times daily for pain.
Allergies: NKDA
PMH: Not significant.
PSH: ACL repair approximately 1 year ago.
FH: Not significant.
SH: Single high school student who lives with her parents. She denies tobacco and alcohol use.
ROS: The patient has no other complaints today.
PHYSICAL EXAM:
General: Alert and oriented female who appears to be in no acute distress. Appears to be bright, physically fit, and of her stated age.
Vitals: Ht. 5’6”, Wt. 145 lbs.
Back: Localized tenderness over the L5 transverse process with palpation. End point of flexion is painful, and limited to the fingertips reaching approximately two feet from the floor. Lateral bending does not cause radicular type symptoms. There is right side pain with arabesque and hyperextension of the back. Right-sided straight leg raise and neural dural stretch tests are positive. Obvious tightness of the hamstrings is absent bilaterally. Bilateral hips are non-tender, stable, and have full range of motion and full strength. Patellar and Achilles deep tendon reflexes are +2/4 bilaterally. Babinski sign is down going bilaterally.
The athlete has significant discomfort with examination of the back.
Initial Differential Diagnosis Based on the History and Physical:
