31 year old male builder referred with two months of low back pain starting after he picked up a 30kg block and twisted and felt a โpopโ in his lower back causing immediate pain
VAS 4-5 to 7/10
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31 year old male builder referred with two months of low back pain starting after he picked up a 30kg block and twisted and felt a โpopโ in his lower back causing immediate pain | 31 year old male builder referred with two months of low back pain starting after he picked up a 30kg block and twisted and felt a โpopโ in his lower back causing immediate pain | ||
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VAS 4-5 to 7/10 | VAS 4-5 to 7/10 | ||
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*On 22/10/19 he was lifting & throwing concrete into skip bin. Picked up a 30kg block and twisted and felt โpopโ in his lower back & immediate pain | *On 22/10/19 he was lifting & throwing concrete into skip bin. Picked up a 30kg block and twisted and felt โpopโ in his lower back & immediate pain | ||
*Worked on and that evening he had significant low back pain | *Worked on and that evening he had significant low back pain | ||
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*Canโt comfortably hold 7 month infant | *Canโt comfortably hold 7 month infant | ||
*Poor sleep โ best on side pillow between knees | *Poor sleep โ best on side pillow between knees | ||
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Examination= | |||
*An engaging man not obviously in pain | *An engaging man not obviously in pain | ||
*Could reach middle of shins; L. ext. hurt | *Could reach middle of shins; L. ext. hurt | ||
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*Blunting of pin prick dorsum right foot | *Blunting of pin prick dorsum right foot | ||
*Antalgic weakness | *Antalgic weakness | ||
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Imaging= | |||
[[File:Interspinous_Oedema_MRI.jpg]] | [[File:Interspinous_Oedema_MRI.jpg]] | ||
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Ask for a T2 fat suppressed Dixon coronal. Corroborate the coronal ISO in the sagittal plane. Have the sequence start posterior to the spines. A STIR will suffice but less resolution }} | Ask for a T2 fat suppressed Dixon coronal. Corroborate the coronal ISO in the sagittal plane. Have the sequence start posterior to the spines. A STIR will suffice but less resolution }} | ||
}} | }} | ||
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Management= | |||
[[File:Interspinous_Oedema_Fluoroscopic_Injection.jpg]] | [[File:Interspinous_Oedema_Fluoroscopic_Injection.jpg]] | ||
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*A mixture of 40 mg Kenacort A and 0.5 mL 0.75% Ropivacaine was infiltrated into the L4/5 interspinous space. | *A mixture of 40 mg Kenacort A and 0.5 mL 0.75% Ropivacaine was infiltrated into the L4/5 interspinous space. | ||
*No immediate complications. | *No immediate complications. | ||
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Follow up= | |||
'''24th January 2020ย (14 weeks post injury)''' | '''24th January 2020ย (14 weeks post injury)''' | ||
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His straight leg raise was increased on the right to approximately 80 degrees limited by hamstring tightness, and on the left to 70 degrees limited by hamstring tightness. | His straight leg raise was increased on the right to approximately 80 degrees limited by hamstring tightness, and on the left to 70 degrees limited by hamstring tightness. | ||
There was no tenderness to palpation in his buttocks or spinous and interspinous processes today. | There was no tenderness to palpation in his buttocks or spinous and interspinous processes today. | ||
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Related Articles= | |||
*[[Interspinous Oedema]] | *[[Interspinous Oedema]] | ||
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[[Category:Case Histories]] | [[Category:Case Histories]] |
31 year old male builder referred with two months of low back pain starting after he picked up a 30kg block and twisted and felt a โpopโ in his lower back causing immediate pain
VAS 4-5 to 7/10
7th January 2020 (11 weeks post injury)
I reviewed P today and explained to him that he used his โget out of jail cardโ with the successful interspinous focal steroid injection between L4 and L5 has treated the periostitis and ligament injury. Within days he had an improvement in the local pain and the impulse pain and was moving freely. He lost his impulse pain and began to move freely. Examination I saw him jog across the road today as he was running late, so I think he is moving freely. His general movements are fine without any obvious issues. He was able to bend forward and effortlessly reach just to his ankles; extension was normal. His straight leg raise was increased on the right to approximately 80 degrees limited by hamstring tightness, and on the left to 70 degrees limited by hamstring tightness. There was no tenderness to palpation in his buttocks or spinous and interspinous processes today.