Disclosures: Alexandra E. Fogarty, MD: No financial relationships or conflicts of interest

Case Description: Young athletes with low back pain have a high incidence of bony structural injuries. We present the case of a fracture within the superior articular process of a facet joint.

Setting: Tertiary referral hospital.

Patient: We present the case of a 16-year-old female swimmer with a past medical history of lumbar spondylolysis who presented with recurrent low back pain. She noted difficulty with hyperextension, notably during the butterfly stroke. She had completed a course of physical therapy, which did not provide sustained relief. Imaging revealed a loose osseous body measuring 6.6 x 3.9 mm in the L5-S1 facet joint, originating as from the superior facet of S1 and was negative for an acute pars fracture. Assessment/

Results: The patient underwent a right L5-S1 facet joint injection under fluoroscopic guidance without complications. Following the procedure, she noted 100% pain reduction. This relief was sustained up to 75% for 2 weeks following the injection. Unfortunately, after 2 weeks of relative rest, she returned to swimming and symptoms recurred.

Discussion: Symptomatic fractures of facet joints are seldom reported in young athletes. However, its incidence may be underrepresented as the clinical presentation overlaps with acute pars interarticularis fracture, which is seen in 4-6% of athletes with low back pain. Facet fractures are important to consider when evaluating young athletes, as the treatment course and prognosis may be different. For example, the role of conservative management is not well characterized. In the present case, the injection of the facet joint appears to have an important diagnostic role, but its therapeutic value remains in question.

Conclusion: While pars fractures may be treated with conservative measures, facet joint fractures may require further intervention. It is important to have a high suspicion for this diagnosis when evaluating low back pain in young adults. However, more data is required to determine the optimal course of treatment.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/asymptomatic-intraarticular-facet-joint-fracture-in-a-16-year-old-competitive-swimmer-a-case-report/