Shoulder Injury - Tennis Player

HISTORY: Patient is a 61-year-old avid tennis player who began to experience shoulder pain five years ago. She had been playing five times weekly for twenty years. Patient presented to clinic complaining of localized shoulder pain and decreased range of motion. Patient reporting dull pain at rest (5/10 as measured by Numeric Pain Related Scale). While playing tennis, her pain became sharp and more bothersome (NPRS, 8/10). She did not report any weakness or paresthesias. Initial treatment with oral diclofenac, physical therapy, corticosteroid injections did not provide relief of symptoms. Patient was interested in a trial of platelet-rich plasma injections. PHYSICAL EXAMINATION: Pain on palpation to anterolateral and superior aspect of left shoulder. Mild weakness noted on left side with arm abducted and internally rotated. Active range of motion limited secondary to pain with abduction. Passive range of motion within normal limits. DIFFERENTIAL DIAGNOSIS: 1. Rotator cuff tear 2. Subacromial bursitis 3. Arthritis of glenohumeral or acromioclavicular joint 4. Cervical radiculopathy TEST AND RESULTS: MRI left shoulder: - 8 mm partial tear along bursal surface of supraspinatus tendon - Advanced osteoarthritic changes of glenohumeral joint FINAL WORKING DIAGNOSIS: Large partial supraspinatus tear with associated tendinosis TREATMENT AND OUTCOMES: - Patient received platelet-rich plasma injection of the supraspinatus tendon - Patient was advised to slowly increase activity as tolerated over the next two weeks. - Patient reporting significant improvement in pain at six week followup (NPRS, 0/10) - Patient returned to clinic at week sixteen for another PRP treatment, and has since received a total of eight treatments. - Patient has returned to her desired level of activity without limitations from shoulder pain (NPRS, 2/10 or better). She plays tennis twice weekly and has started playing pickleball as well. Patient consent: Patient consent was obtained. HCA Healthcare disclaimer:This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.