15 yo with left lower back pain for 2 weeks, following a hip-check which landed him on his back.
HPC: 15 yo presents with left lower back pain to clinic 2 weeks after initial injury. He was playing hockey, got hip-checked and landed on his back. He had pain with skating and shooting afterwards. He reports occasional pains waking him up from sleep. He has no caudal equina or neurological symptoms. He describes pain with shooting, running, and jumping.
OE: His neurological examination is completely benign with normal power, sensation, reflexes, coordination, and tone. He has no anaesthesia, leg length discrepancy. His slump testing, straight leg raise and sacroiliac testing is all normal. His hip exam is also normal. He has no pain with back flexion, however experiences pain with extension, and extension while standing on left leg (stork testing). His stork testing on his right leg produces no pain. There is no midline tenderness, however he is tender over his left L5 Transverse process.
An xray was ordered see above, and below Figure 6 for a close up.
Figure 6 – Close up of AP spine, demonstrating non-displaced Left Transverse Fracture of the L5 vertebrae
Assessment: Left L5 non-displaced fracture of the transverse process
Recommended rest from impact activities such as running, jumping and impact from contact in hockey. MRI to assess healing in 6-8 weeks. Reassessment in 6 weeks to check for point tenderness and consider progression to impact activities as pain allows.
Dr. Neil Dilworth (Nov 20, 2015)