Objective: The purpose of this report is to describe the management of a patient with lower back and right-sided lower extremity pain originating from multiple deep vein thromboses.
Clinical Features: A 24-year-old female collegiate runner with a history of right gluteal and thigh pain lasting for 2 weeks sought chiropractic care for her ongoing low back pain and right sided lower extremity pain. A physical exam identified a concerning “red flag” for serious pathology contributing to this young woman’s acute lower back pain and associated right lower extremity pain.
Intervention and Outcome: This patient was evaluated, and the clinical exam raised suspicion of a possible deep vein thrombosis as a source of her pain. An immediate referral was placed for further diagnostic work-up at a nearby emergency room where 3 thromboses were identified in the patient’s right lower extremity. The patient was treated with intravenous anticoagulant therapy for 3 days in the hospital setting, then underwent 6
months of oral anti-coagulant medication, along with activity modifications. The patient was diagnosed with Factor V Leiden Thrombophilia, after being referred to a hematologist for further evaluation.
Conclusion: We recommend clinicians stay mindful of all factors contributing to low back pain combined with lower extremity radicular symptoms. In this case, consideration of additional pathologies resulted in the identification of multiple deep vein thromboses as a source of right lower extremity pain imitating sciatic symptoms.
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