Objective: The purpose of this case report is to describe the case of a young female athlete with low back pain caused by metastatic breast cancer.
Clinical Features: A 27-year-old woman presented with low back pain after striking a ball during kickball 3 days earlier. Because of the mechanism of injury and onset, the patient was originally diagnosed with a lumbar spine sprain/strain.
Intervention/Outcome: After radiographs were obtained and were read as unremarkable, a 2-week trial of care was initiated that included soft-tissue mobilizations, anti-inflammatory medications from her primary care physician, and therapeutic rehabilitation exercises. After this trial concluded, the patient did not improve and continued to be in significant pain. Magnetic resonance imaging was then ordered and revealed an expansile lesion at L2 with cortical compromise. Referral to an oncologist prompted the diagnosis of stage IV breast cancer.
Conclusion: Poor response to conservative treatment may indicate the working diagnosis is incorrect and that it must be reconsidered. In this case, a lack of response to care with persistent high severity of pain despite a multimodal approach justified further investigation with advanced imaging, which revealed spinal metastases secondary to breast cancer. Clinicians should be aware of history and physical exam indicators of red flag conditions that may present as low back pain.
Author keywords: Breast Neoplasms; Female; Athletes; Fractures, Bone; Fractures, Spontaneous; Lumbar Vertebrae; Magnetic Resonance Imaging
Author affiliations: Private Practice (United States / North Carolina / Holly Springs)
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