Back Pain-Volleyball

Abstract

HISTORY A 12 y/o female volleyball player sustained a fall from her feet while jumping, landing on a sitting position and developed severe mid-back pain which initially required analgesics and discontinuing sports participation. The patient suffered a similar episode 3 months later and developed intractable mid-back pain relieved only by opioid medications, limited back range of motion, and gait difficulties. She denied numbness, tingling, weakness, or radiation of pain to the lower extremities. PHYSICAL EXAMINATION The patient showed mild to moderate tenderness to palpation over the mid-thoracic spinous processes and paraspinal muscles bilaterally. There was evidence of decreased flexion, extension, and rotation of trunk secondary to pain. She had adequate sensation and tone with evidence of symmetric hyperreflexia and absence of corticospinal reflexes. Muscle strength was at least 3+/5 in all extremities. DIFFERENTIAL DIAGNOSIS Thoracic Muscle strain spasms/ Myofascial pain Spondylolisthesis/ Spondylolysis Herniated disc Thoracolumbar apophysitis Vertebral fractures Diskitis Leukemia/ Neoplasm TEST AND RESULTS Thoracolumbar computerized tomography: T7-T9 vertebral compression fractures DEXA scan: Osteopenia of lumbar spine age-adjusted Bone marrow biopsy: B-lymphoblastic leukemia FINAL/WORKING DIAGNOSIS Vertebral compression fractures T7-T9 secondary to neoplastic process (ALL) TREATMENT AND OUTCOMES Immobilization with Jewett Orthosis Analgesic medications Physical therapy modalities Back extension strengthening exercises Pectoralis muscles stretching exercises Chemotherapy Radiation therapy Pain improvement and gradual return to activity