Case Study: Shoulder Tendinitis or Partial Thickness Tear?

Our Patient

Our patient is a 55 year-old male with sharp pinpoint anterior shoulder pain, aggravated when lifting with resistance, and when raising the arm above 90 degrees.

The Challenge

The patient had gone to physical therapy elsewhere, with no tangible results. He then went to a pain management doctor who referred him for an MRI. The imaging revealed a partial thickness tear in the affected rotator cuff.

The doctor injected the lesion with platelet rich plasma (PRP) twice, with no results.

Our Diagnostic Approach

We used high resolution ultrasound imaging to examine the rotator cuff and confirm the tear. We then used ShowMotion technology to evaluate the patient’s shoulder movement parameters. ShowMotion is an objective tool for analyzing joint movement quality with the use of wearable motion tracking sensors.

Showmotion is the first technology of its kind to show the kinematics of the glenohumeral joint and the scapula, and their relationship during shoulder girdle movement. It is an indispensable tool for precise rehabilitation of shoulder disorders.

Our Treatment Solution

Prior to beginning physical therapy, we performed dry needling to eliminate myofascial trigger points, followed by 6 sessions of shockwave therapy (ESWT) and extracorporeal magnetic transduction therapy (EMTT) to reduce pain and inflammation, and stimulate cell regeneration in the healing rotator cuff tear.

After 6 weeks of pre-hab, the patient was pain-free and ready to move on to physical therapy for strengthening and improved range of motion. We released him when he was ready to return to the gym.

Discussion

The patient had originally been treated with physical therapy, followed by two PRP injections, with no improvement in shoulder function. It is important to note that PRP can be proinflammatory, and should not be used as a first-line treatment for shoulder pain. In some cases, ruptures injected with PRP can become worse.

In cases of tendinopathy, PRP therapy should only be introduced after conservative prehab that includes shockwave therapy. Scapular stability should be addressed first, and causes and mechanisms should be considered. Shockwave therapy gives superior results to PRP, especially when combined with physical therapy.

To treat rotator cuff tears, a personalized patient-centric approach using regenerative technologies and physical therapy should be used to rehabilitate the entire shoulder girdle. Treating the tendinopathy while ignoring shoulder girdle mechanics is unlikely to be successful. PRP may be introduced after prehab, but injections should be ultrasound-guided, and the PRP should have a high concentration of platelets.