LEG PAIN- BASEBALL PLAYER

Abstract

1772 HISTORY - A 13 year old recreational basketball and baseball player presented with a 3 1/2 month history of posterior thigh pain and hamstring muscle tightness. The pain started insidiously, without antecedent trauma, and he denied prior injury to this region. He had been evaluated 2 months previously by a Sports Medicine physician and was treated for a chronic hamstring muscle strain. His home therapy program consisted of icing, stretching, and strengthening. He did not have significant improvement with this program and thus sought further evaluation. His current symptoms consisted of an achy pain in the posterior thigh that became sharp in nature with dynamic activity such as playing baseball. He denied numbness, tingling, weakness or pain that radiated below the knee. Prior femur radiographs were negative. PHYSICAL EXAMINATION - His general appearance was that of a healthy adolescent male, however his gait was antalgic with decreased knee extension. He had normal lower extremity muscle strength, reflexes and sensation, and no evidence of muscle atrophy. Straight leg raise was positive with pain in the posterior thigh, ipsilateral hip hiking, and right sided low back pain at 20 degrees. Crossed straight leg raise was negative. Hip, knee, and ankle range of motion was normal. There was significant asymmetry in hamstring flexibility with a popliteal angle of 85 degrees on the right and 20 degrees on the left. There was no tenderness to palpation in the right posterior thigh and no evidence of a soft tissue defect. No swelling or erythema was present. DIFFERENTIAL DIAGNOSIS: Chronic hamstring muscle strain or tear Lumbosacral radiculopathy Femoral stress fracture Intra-articular hip pathology TESTS & RESULTS: MRI of the right lower extremity - No evidence of a muscle tear, mild right hamstring muscle atrophy. Electromyography of the right lower extremity - Consistent with a chronic, active right S1 radiculopathy. MRI lumbar spine - Right paramedian focal disk protrusion at the L5 disk which compressed and displaced the right S1 nerve root sleeve. FINAL/WORKING DIAGNOSIS: Right S1 radiculopathy TREATMENT: Initial - Dynamic lumbar stabilization program, hamstring stretching, myofascial release & strain counterstrain. The patient's symptoms improved however there was no change in hamstring muscle tone, popliteal angle or gait. Surgery - L5-S1 diskectomy to decompress the right S1 nerve root.