C-22 Clinical Case Slide - Cardiopulmonary II

Abstract

HISTORY: A 16 year-old male defensive football player sustained a back injury while being tackled. An opposing player, on top of the patient, drove a knee into his back. The patient heard a crack and felt “the wind get knocked out of him”. He had difficulty taking a deep breath, but remained neurovascularly intact. He presented 6 days after the injury with resolution of pain for 3 days. He had not returned to physical activities. Two-years prior the patient sustained a similar acute injury while being tackled in football. He denied neurovascular symptoms, but was unable to return to play secondary to back pain. He sustained anterior wedging of T3 and T8 consistent with vertebral compression fractures. Family history includes pancreatic cancer, T-cell lymphoma and idiopathic flat-back. PHYSICAL EXAMINATION: AAO × 3, NAD, BMI 20.2 kg/m2, cervical, lumbar spine and paraspinal musculature non-tender, palpation of thoracic spinous processes revealed mild tenderness, FROM of spine without pain in flexion, extension and side-bending, 5/5 strength and 2/4 DTRS throughout upper and lower extremities, sensation intact DIFFERENTIAL DIAGNOSIS: 1.Vertebral compression fracture 2.Pneumothorax 3.Vertebral contusion 4.Paraspinal muscle strain 5.Vertebral disc pathology 6.Spondylolysis 7.Spinal process apophysitis 8.Metastatic vs. primary bone tumor TEST AND RESULTS: Thoracic spine radiographs: -previous T8 vertebral body compression fracture less apparent -vertebral body heights and disc spaces preserved Chest radiographs: -clear lung fields without effusion or pneumothorax -normal heart size, pulmonary vasculature, bones and soft tissues Thoracic magnetic resonance image without contrast: -compression fractures of T9, T10 and T11 vertebral bodies -no central or foraminal stenosis and normal soft tissues FINAL WORKING DIAGNOSIS: Second occurrence of vertebral compression fractures at new vertebral levels; T9-T11 TREATMENT AND OUTCOMES: 1.Rest from activity for 6 weeks 2.Physical therapy and gradual return to play over 2 weeks 3.Despite strong recommendations to not return to football, the patient returned 8 weeks after his injury without complications 4.DXA was not obtained secondary to traumatic fractures, no underlying illness or medication use and no family history of fracture.