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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Subacute nerve root lesion in a competitive amateur tennis player – diagnostic and therapeutic procedures

Meeting Abstract

  • corresponding author presenting/speaker Ulrike Jirasek - Institute of Physical Medicine and Rehabilitation Kaiser-Franz-Joseph-Hospital, SMZ-Süd, Kundratstraße 3, 1100, Vienna, Austria
  • author Martina Angst - Institute of Physical Medicine and Rehabilitation Floridsdorf Hospital, Hinaysgasse 1, 1210, Vienna, Austria
  • author Birgit Stabauer - Institute of Physical Medicine and Rehabilitation Floridsdorf Hospital, Hinaysgasse 1, 1210, Vienna, Austria
  • author Barbara Horvath-Mechtler - Institute of Radiology Kaiser-Franz-Joseph-Hospital, SMZ-Süd, Kundratstraße 3, 1100, Vienna, Austria
  • author Doris Pflanzer - Institute of Radiology Floridsdorf Hospital, Hinaysgasse 1, 1210, Vienna, Austria
  • author Michael Quittan - Institute of Physical Medicine and Rehabilitation Kaiser-Franz-Joseph-Hospital, SMZ-Süd, Kundratstraße 3, 1100, Vienna, Austria

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm191

DOI: 10.3205/11esm191, URN: urn:nbn:de:0183-11esm1914

Published: October 24, 2011

© 2011 Jirasek et al.
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Outline

Text

Objective: A 54 old, right handed, male amateur tennis player sought medical advice for persistent low back pain with irradiation in the left thigh since 6 weeks after a lumbar spine retroflexion trauma due to a tennis match.

He reported low back pain irradiating in the left thigh and shank partially combined with paraesthesia, and discovered a weakness in the knee extensor muscles, disabling him to raise from a squatting position.

Material/Methods: Prominent findings were a missing left patellatendon nreflex, paraesthesia on the left thigh ventrally, on the left lower leg laterally and medially, as well as painful springing test L4/L5, lateralflexion to the left side and retroflexion of the lumbar spine.

Lasegue and Femoralislasegue manoeuvres were negative bilaterally.

Muscular strength of the left m. quadriceps femoris compared to the collateral side was mildly reduced.

Measuring the circumference of the left thigh showed a significant difference in comparison with the right thigh about 2 cm less.

Results: Conventional radiographs of the lumbar spine showed degenerative changes in the intervertebral disk of L4/L5 and facet joint arthrosis the lower lumbar vertebra.

Magnetic resonance imaging showed a small disc protrusion, containing a significant amount of water, L3/L4 on the left touching the radix L3, and disk protrusions L4/L5 bilaterally, oedema of the facet joints L4/L5 bilaterally and the processus spinosi at L4/L5 and L2/L3.

Magnetic resonance imaging of the thigh bilaterally showed a diffuse atrophy most pronounced in the mm. adductor magnus and vastus medialis, minimal oedema in the M.adductor magnus and increase in fatty tissue between the fasciae of the thigh muscles.

Electroneuro and -myography were without pathological findings.

Combining clinical and radiological findings, we diagnosed a subacute L3 left nerve root lesion. We conducted a CT-guided intraforaminal injection with 2 ml triamcinolonacetonid 80 mg and 3 ml Licocain HCL 1% at the level of L3/L4 leftside.

The pain subsided within one day. We advised the patient to refrain from sport activities and initiated an exercise program for muscular trunk stabilisation and activation and specific strength training for the weak end left thigh muscles. The patient returned to sports activity after 2 weeks.

Conclusion: Although MRT showed multiple pathological findings all of them associated with tennis sport, careful clinical examination identified irritation of lumbar nerve roots as prominent painful and debilitating factor. Interventional pain therapy provided rapid pain relief and functional recovery thus confirming the diagnosis.

In this case, diskogenic low back pain diagnosed and treated aggressively can shorten injury related inactivity and facilitate rapid return to sports in amateur tennis.