127: LUMBAGO

PATIENT PRESENTATION

A 27-year-old emergency room nurse presents with a low back injury while assisting in lowering a patient from an ambulance onto the pavement outside the hospital. Instead of facing the patient stretcher directly, she bent forward with a twist to one side and had to give a quick tug to lift along with the other personnel. It was much heavier than she expected, and it caught her off guard. She felt something “snap” in her back and experienced severe mid-lumbar pain. For several minutes she was unable to move from the semiflexed position and then gradually moved upright. The pain was intense for ~5 minutes, then eased off but increased again 30 minutes later and became progressively worse over the next few hours. This injury occurred 10 days ago.

Presently any movement causes pain, and bending forward is impossible. There is relief when lying supine or side lying, although prone lying and turning over in the bed aggravate the pain. Sitting relieves pain, although moving from sit to stand is very guarded, and she eases herself slowly down when returning to sit relying heavily on her arms for support. She identifies that the maximal site of the pain is in the L3-4 region.

There is point tenderness in the L4-5 region. Straight leg raise (SLR) is 80° bilaterally, and sacroiliac tests are negative. X-rays are negative for fracture and r/o spondylolisthesis.