Had an interesting acute lumbar pain presentation a week or so ago..
70yo female presented with an 8/52 hx of mid left lumbar pain which initially presented after a four wheel driving holiday. The pain initially resolved with panadol osteo and rest but then flared again after going to Curves. Pain was largely achey and stiff but then she would get intense, spasming flared ups, generally due to a change of position. There was no LEX neuro symptoms, however she did note intermittent pain to the legs which was worse when supine. Bowel movements and similar abdo pressure changes also aggd the lower back pain. Flexion rel'd the pain.
Based on the description above my tentative working diagnosis was a disc injury (most likely predisposed to by degen changes) although i had some reservations as the nature of the pain didn't quite fit the usually presentation of a disc injury.. I attributed the prolonged sitting and getting in an out of the car and packing unpacking the car as being likely causes for the injury. I sent her for an xray as an initial investigation to determine the extent of any degeneration and determine whether anything else was going on.
X-ray findings - acute fracture of the superior end plate of L4 with decreased bone density.
Turns out she has suffered a compression fracture from bouncing around in the 4wd!!
So far treatment has provided some good relief for the patient and her home based management is now much better. I have treated her twice and have now put her under the care of her GP for further investigation and osteoporosis education/management.
From a clinical point of view, it was good to see one of these injuries in an acute phase and i certainly was able to learn a lot from it for future reference!
Belmont
02 4945 4245
Warners Bay
02 4954 4511
