Ankylosing Spondylitis Presenting as Buttock Pain in a Military Tactical Athlete: A Case Report

Abstract

BACKGROUND: Ankylosing spondylitis (AS) is an inflammatory condition that most commonly affects the spine. In the absence of spinal symptoms, consideration of atypical symptom behavior and the use of diagnostic criteria can be helpful in recognizing this condition. The purpose of this case was to detail AS presenting as buttock pain in a military tactical athlete. CASE PRESENTATION: A 20-year-old white male military intelligence specialist was referred to physical therapy for reports of right buttock pain. Symptoms developed during recruit training, which led to an initial diagnosis of overuse syndrome. He was managed by multiple health care providers, including physical therapists, during recruit training and a year following onset while deployed overseas. OUTCOME AND FOLLOW-UP: Lack of treatment response and presence of atypical symptoms necessitated further medical workup, including radiography, laboratory, and rheumatology referrals. Following consultation with a rheumatologist, a diagnosis of AS was confirmed and the patient was provided definitive and appropriate management that resulted in improved outcomes. DISCUSSION: Spinal pain is often associated with AS. Indicators of AS such as an insidious onset of nonresolving symptoms, night disturbances, patient demographics, a positive HLA-B27 laboratory value, and evidence of active inflammation or sacroiliitis on imaging may help guide detection in the absence of spinal pain or absence of specific criteria established to assist in the identification of inflammatory spondyloarthropathies. Diagnostic accuracy is essential for appropriate care earlier in the disease process. In this case, a definitive diagnosis led to improvement in the management of this patient. JOSPT Cases 2023;3(2):110–116. Epub: 13 April 2023. doi:10.2519/josptcases.2023.11596