| 제목 |
Multiple Thoracic Spinous Process Fractures in an Amateur Golfer |
| 소속 |
Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Department of Physical Medicine and Rehabilitation1 |
| 저자 |
Kyo Hun Ku1*, Young Sook Park1†, Hyun Jung Chang1, Jin Gee Park1, Eun Sol Cho1, Jae Sam Seo1, Chang Woo Kim1, Se Hwi O1, Da Hye Kim1 |
Introduction
Amateur golfers who enjoy golf are increasing these days. Like other sports, golf can cause various types of injury to the musculoskeletal system. There have been case reports of golf swing-related stress fracture of the ribs, ulnar diaphysis, vertebral body, the hook of hamate, and sternum. Clay-Shoveler’s fracture or Avulsion of the spinous process is an isolated spinous process fracture of the lower cervical or upper thoracic vertebrae. Such fractures are caused by the shear force applied to the dorsal neck and are most likely to occur in workers with hard physical labor. To the best of our knowledge, this is the first report of multiple stress fractures of the spinous processes of T2 and T3 vertebrae in an amateur golfer.
Case report
A 36-year-old male visited our outpatient clinic with a 2-week history of back pain. He started playing golf two weeks before the pain began. Two weeks ago, he felt a sudden sharp pain in his back while practicing his golf swing. There was no radiating pain delivered to the upper extremity. He stopped playing golf for two weeks and the pain decreased. He recently started playing golf again and had the same pain in his back as before. In the patient's past history, there was no notable history of medical illness such as diabetes, osteoporosis, high blood pressure, and cancer. In the physical examination, there was tenderness on the upper thoracic spinous process. No swelling or redness was observed in areas with pain or tenderness. He had a limitation of neck motion due to pain. The neurologic examination was normal. Radiograph findings were normal. We suspected fracture because of severe pain and tenderness on the upper thoracic vertebrae area and conducted cervicothoracic spine computed tomography (CT) and magnetic resonance imaging (MRI). The CT revealed the fracture of the spinous processes of T2 and T3 vertebrae. In the MRI, the same fractures were observed, in addition to the bone edema of the T3 spinous process. The spinal cord was normal. The patient was prescribed non-steroidal anti-inflammatory drugs, muscle relaxant, cervical immobilization was maintained for 4 weeks with a neck collar and weight-bearing restrictions. After cervical bracing and pain medication, the patient gradually recovered.
Conclusion
The stress fractures of the spinous process of upper thoracic vertebrae are very rare and can be overlooked in clinical settings. If a patient complains of long-standing dorsal neck and upper back pain and has a history of golf play, the upper thoracic spinous fracture should be suspected and ruled out.
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Fig 1. Midsagittal CT scan (A) and Sagittal T2-weighted MR image (B) showing a fracture of the spinous processes, T2 and T3 with surrounding bone edema, T3 on MRI
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