Shoulder Pain In A Basketball Player

HISTORY: A 40-year-old male with no past medical history presented to the sports medicine clinic in August 2021 with right shoulder pain that started during a basketball game. The patient was going for a rebound when he hyperflexed and hyperabducted his right arm as he was battling another player for the rebound. Since then, he noted anterior shoulder pain, clicking, instability and difficulties reaching overhead. He reported a high level of year round recreational basketball playing time. Despite brief rest from basketball, symptoms persisted and limited his ability to play. He denied neck pain, previous shoulder dislocations, and right upper extremity numbness, weakness and pallor. PHYSICAL EXAMINATION: There was tenderness to palpation to the bicipital groove. There was pain with all active ranges of motion (ROM) and resisted ROM in the right shoulder. Passive ROM was full in all planes. Special testing was positive for Jobe, O’Brien’s, Speed’s and Crank tests on the right shoulder. DIFFERENTIAL DIAGNOSIS: Biceps Tendinosis, Rotator Cuff Tendinosis, Rotator Cuff (Supraspinatus) Tear, Shoulder Labral Tear, Shoulder Subluxation TEST AND RESULTS: An X-ray of the shoulder was without evidence of glenohumeral joint (GHJ) arthritis, fractures, acromioclavicular joint sprain or GHJ dislocation. An MRI shoulder without contrast demonstrated a SLAP tear. FINAL/WORKING DIAGNOSIS: Superior Labrum Anterior to Posterior (SLAP) tear TREATMENT AND OUTCOMES: The patient was initially managed with physical therapy (PT), non-steroidal anti-inflammatories and a GHJ corticosteroid injection. Unfortunately, his symptoms continued. After shared decision making, the patient opted for a GHJ injection with platelet rich plasma and reconstituted stem cell treatment. At the 3 week post-injection follow up, the patient had full range of motion in all planes and resisted range of motion without pain. At the 6 week post-injection follow up, the patient began 6 weeks of PT. He subsequently returned to basketball without issues. Three years later, the patient had recurrent R shoulder pain triggered while going for a rebound. A repeat MRI shoulder without contrast demonstrated a normal labrum with biceps tendinosis, suggesting that PRP and stem cell treatment healed the SLAP tear.