Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Ajay K. Patel, MD: No financial relationships or conflicts of interest
Case Diagnosis: A 35-year-old male with right L1 radiculopathy due to schwannoma.
Case Description: A 36-year-old male presented via telehealth visit with 3-month history of intermittent pain in low back, right testicle, and right upper thigh that began while hiking in Central America. The pain was described as an aching quality, worse with lying supine and sitting, and improved with standing. He denied paresthesias, weakness, and bowel/bladder incontinence. Prior work-up included a testicular ultrasound at a local Emergency Department around the time of onset reportedly showing epididymitis for which he received antibiotics and analgesics followed by temporary resolution of his symptoms. Physical exam was limited due to telehealth during the COVID-19 pandemic, but was notable for full active range of motion of the right hip and lumbar spine with only minimal pain at end-range forward flexion of the lumbar spine. Patient-performed slump test was negative.
Setting: Outpatient sports medicine clinicAssessment/
Results: A MRI lumbar spine showed an enhancing, 10mm x 10mm x 16mm intradural, extramedullary mass at the level of T12-L1 compressing the L1 nerve root. The patient was diagnosed with right-sided L1 radiculopathy due to an intradural, extramedullary mass. The patient underwent a successful T12-L1 laminectomy and resection of his tumor, and pathology was consistent with a schwannoma. At his follow up visit, he had complete resolution of his symptoms.
Discussion: Causes of lumbar radiculopathy commonly include disc herniations, spinal stenosis, and less frequently, tumors. L1 radiculopathy is infrequently seen because disc herniations at this level are uncommon. L1 radiculopathy typically presents with low back pain radiating to the groin and paresthesias in the inguinal region. While motor weakness is possible, it is uncommon at this level, which makes it difficult to diagnose.
Conclusion: Clinicians should consider L1 radiculopathy among the differential diagnoses for groin pain, especially in the setting of concurrent low back pain.
Level of Evidence: Level V
To cite this abstract in AMA style:
Patel AK, Bartolo KB, Siddiqi AR. The Path Less Traveled – An Unusual Case of Back Pain in a Hiker: A Case Report [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-path-less-traveled-an-unusual-case-of-back-pain-in-a-hiker-a-case-report/. Accessed May 21, 2025.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-path-less-traveled-an-unusual-case-of-back-pain-in-a-hiker-a-case-report/