Presentation:
Mitch, a 26 year old Landscape Gardener called the clinic asking for an appointment. He’d been referred to us by a current patient – a professional dancer who’d had successful treatment for hip and groin pain.
Symptoms:
Mitch’s chief complaint was a 7yr history of left lower back pain. He had suffered recurrent episodes approximately every 6 months since high school. The pain was described as “severe” and “sharp” in the lower back but he also had “dull” pain and paraesthesia into both feet and both hands.
The symptoms were aggravated by long periods of standing and relieved by sitting. Valsalva sign was absent but he later reported that he’d been experiencing erectile dysfunction and intermittent loss of bladder control over the last 4 years. However the erectile dysfunction had been worse in the last twelve months.
Mitch was now struggling to work in his landscaping business and was considering walking away from it.
He could no longer cycle for more than 20 minutes before the pain and fatigue set in.
He had given up all hope of being in another close relationship and had therefore stopped dating.
History:
Mitch was an avid cyclist and snowboarder and suspects that his symptoms began after a severe snowboarding fall in Canada many years prior. After the fall he could not move for two weeks but didn’t have travel insurance, so he decided to “just wait for the pain to go away”. It was 5 weeks before he could move relatively freely.
Apart from the previously mentioned snowboarding fall Mitch had experienced many other falls over the years. These resulted in various minor fractures, such as fingers. When he was 16yo he had a separated left acromio-clavicular, for which he underwent surgical reduction.
He was on no regular medication.
Examination:
Mitch was a tall (183cm) young man, with a lean and muscular physique.
Orthopaedic:
Cervical ranges of motion were all slightly reduced by approximately 20° without pain. Lateral flexion was reduced by approximately 50% throughout without pain.
Lumbar ranges of motion were all restricted to approximately 20° by pain at the left lumbo-sacral junction with the exception for forward flexion, which was normal.
Straight Leg Raise produced pain at 40° over the left SIJ.
FABER Test produced groin pain on each side.
Cervical Compression Test produced pain at the lumbo-sacral junction.
Neurological Examination:
All cranial nerves tests were normal and bilaterally equal.
Cervical myotomes and dermotomes were equal and normal.
Lumbar myotomes were equal and normal for L1 to L3 but were reduced to 4/5 on the left for Hamstrings, Gluteus Maximus and Gastrocnemius.
What Is Your Provisional Diagnosis?
If You Have A Differential Diagnosis or Diagnoses, What Is It (or They)?
What Further Tests (if any) Would You Do?
Is This A Chiropractic Case?
(the outcome will follow within a week)
Dr Rob
