1/4. spondylolysis as a cause of low back pain in swimmers.low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Differential diagnosis of spondylolysis in a patient with chronic low back pain.STUDY DESIGN: Resident's case problem. BACKGROUND: A 26-year-old male sought physical therapy services via direct access secondary to a flare-up of a chronic low back pain condition. The patient complained of recent onset of lumbosacral joint pain, including (1) constant right-sided deep-bruise sensation, (2) intermittent right-sided sharp stabbing pain, and (3) constant bilateral aching. The patient's past medical history included a hyperextension low back injury while playing football at age 17. physical examination revealed (1) deep pain with palpation over the right lumbosacral joint region, (2) sharp right lumbosacral joint pain with 1 repetition of active trunk backward bending, and (3) a marked increase in pain and joint hypomobility with right unilateral joint assessment at the L4 and L5 spinal levels. DIAGNOSIS: The examining therapist referred the patient for radiographic evaluation due to strong suspicions of a pars interarticularis bony defect. Lumbar plain films, oblique views, revealed an L5 bilateral pars defect, leading to a diagnosis of a longstanding bilateral L5 spondylolysis. DISCUSSION: patients with low back pain often seek physical therapy services. Identification of pathology requiring examination by other health care providers, leading to patient referral to other health care practitioners, is a potential important outcome of the therapist's examination. This resident's case problem illustrates the importance of a systematic examination scheme, including a thorough medical screening component that led to a patient referral for radiographic evaluation. The resultant diagnosis, although not representing serious pathology, did impact the therapist's patient plan of care.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. spondylolysis of the axis. A case report and review of the literature.Bilateral congenital defects in the pedicles of the second cervical vertebra were noted on conventional x-rays and tomography of a 42-year-old male. He had been assaulted after which he suffered upper neck and occipital pain. Subsequent CT scanning demonstrated the incomplete nature of the axis defects. This is felt to be important in prognosticating the likelihood of spondylolisthesis formation and counselling the patient with regard to acceptable future physical activity. The role of CT examination for this purpose has not been stressed before. The importance of differentiation from old trauma is emphasized.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
4/4. Cervical spondylolysis: three levels of simultaneous involvement.OBJECTIVE: To discuss an interesting case depicting multiple levels of cervical spondylolysis. Differential diagnosis and a brief review of the literature are discussed. CLINICAL FEATURES: A 24-yr-old man suffered from constant neck discomfort of approximately 4 months' duration. After physical examination, x-rays were performed and revealed multiple congenital anomalies. The patient's symptoms are considered independent of the radiographic findings. INTERVENTION AND OUTCOME: This patient was successfully treated with conservative chiropractic management and experienced complete resolution of his presenting symptoms. CONCLUSION: This case nicely demonstrates the congenital nature of cervical spondylolysis. It is unusual in that no prior case report has described three levels of involvement. The spondylolysis and other changes of the neural arch should not be confused with fracture.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |