A 52 year old NZ European man with chronic right low back pain, and mild radiation of pain into the right groin.
His pain drawing is below
He first hurt his back in his 20s playing rugby. A few years ago he reinjured it while snowboarding. His current flare of pain started after using a foam roller on his hips two years ago following yet another snowboarding accident. In 2015 he injured his right knee running which was diagnosed as being caused by a complex meniscal tear with medial chondral fissuring on MRI.
It causes sudden shocks of pain. He does not get any leg pain apart from the knee pain as above. He gets some groin pain but the back is much worse, but these seem to flare up together. The pain is worse in the mornings causing stiffness which lasts about 1-2 hours. He has found certain pain relieving stretches.
He works long hours as a chef which causes discomfort. He surfs for around two hours at a time, twice a week.
He saw an Orthopaedic Surgeon who recommended conservative management, but to proceed to anterior discectomy and fusion at L5/S1 if symptoms became unbearable.
No pertinent contributing psychosocial factors were identified.
FBC, CRP, ANA, anti-CCP, RF, HLA-B27, TFTs, LFTs, HbA1c, and creatinine are all normal.
Celiac antibodies are undetectable consistent with a compliant gluten free diet.
Investigations done 10 months ago by the Orthopaedic Surgeon, and so they are presented before the examination.
The diagnosis is confirmed facetogenic pain arising from the right L3/4, L4/5, and L5/S1 facet joints. He also has mild hip joint osteoarthritis which is largely asymptomatic.