A 35-year-old male elite player presented with back pain after being hit on his left lower back during a match. He could not play the next game due to intense back pain. While he had tenderness over his lower lumbar spine the remainder of his physical examination was normal. There was a normal range of motion of the lumbar spine and lower limbs, no focal neurological symptoms and a negative straight leg raise rest.
An x-ray series of his lumbar spine did not show any definitive abnormality. A subsequent MRI shows a fracture of both the left L2 and L3 transverse processes. There is bony and soft tissue oedema associated with the fracture. There is no significant displacement.
This player was treated with reassurance, simple analgesia and a progressive return to play programme. He was able to resume training seven weeks after his injury.
Transverse process fractures are considered stable lumbar spine fractures. These fractures are normally due to direct blow (heavy impact) to the lumbar region, thereby are sometimes associated to other injuries (e.g. intra-abdominal injuries). In many cases this injury can be diagnosed on the basis of a patient’s history, clinical examination and x-ray findings. In these cases, further investigations are rarely needed.
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