PMC9897030_01
Numeric pain rating scale; 0-10, Initial (initial PRP injection to labrum),1wk-7wk (outcomes post PRP injection), 9wk (2 days-post first prolotherapy injection to ACJ), 10wk-11wk (1-2wk post first prolotherapy injection), 12wk (prolotherapy injection to posterior ACJ), 13wk (final outcome measures taken).
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The subject's pain on the numeric pain rating scale (NPRS) was 5/10 at rest and 8/10 during athletic activity (Figure 1). These findings from the follow-up examination and self-report outcomes (Figure 1, 2) helped confirm the labrum tissue as a potential independent source of pain, allowing a more confident transition into phase II of her orthobiologic intervention. At the three-month (13 week) follow-up after the initial treatment, disability dropped to a 0%, and the subject was able to perform soccer, heavy weightlifting, and intense wrestling practice without limitation or pain (Figure 1, 2).
Quick-Disabilities of the arm shoulder and hand; 0-100%, Initial (initial PRP injection to labrum),1wk-7wk (outcomes post PRP injection), 9wk (2 days-post first prolotherapy injection to ACJ), 10wk-11wk (1-2wk post first prolotherapy injection), 12wk (prolotherapy injection to posterior ACJ), 13wk (final outcome measures taken).
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She described the pain as widespread with poor localization, and her initial Quick-DASH score was 18% (Figure 2). These findings from the follow-up examination and self-report outcomes (Figure 1, 2) helped confirm the labrum tissue as a potential independent source of pain, allowing a more confident transition into phase II of her orthobiologic intervention. At the three-month (13 week) follow-up after the initial treatment, disability dropped to a 0%, and the subject was able to perform soccer, heavy weightlifting, and intense wrestling practice without limitation or pain (Figure 1, 2).
Diagnostic Ultrasound: Anterior View of Acromioclavicular Joint: Initial and 1-Year Follow-up. A: Hypoechoic patterns showing denudement of the distal clavicle and separation of the capsule from the clavicle (A-arrows); tears in the mid and acromial regions of the capsule (B-arrows); and bony abnormalities at the acromion (C-arrows) at initial evaluation. B: Reduction of denudement on distal clavicle (Arrow-A); tissue growth (hyperechoic filling) throughout joint capsule (B-circle); and filling in of bony abnormality (C-arrows), at 1-year follow-up.
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Ultrasound confirmed misalignment of ACJ (clavicular portion elevated) with distinct hypoechoic patterns noted on both the clavicular and acromial attachments of the capsule, with associated bony abnormalities (Figure 3A, 4A). Similarly, a one-year follow-up diagnostic ultrasound revealed normal appearance of the supraspinatus tendon, its myotendinous junction and ACJ (Figure 3B, 4B).
Diagnostic Ultrasound: Posterior View of Acromioclavicular Joint: Initial and 1-Year Follow-up. A: Hyper-calcific regions at the capsule anastomosis of acromion signifying a failing joint capsule or avulsions (A-arrows) at initial evaluation. B: Remodeling of the calcific lesions, tissue growth (hyperechoic filling) and adherence of the capsule to the acromion (B-arrows) at -1year follow-up.
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Ultrasound confirmed misalignment of ACJ (clavicular portion elevated) with distinct hypoechoic patterns noted on both the clavicular and acromial attachments of the capsule, with associated bony abnormalities (Figure 3A, 4A). Similarly, a one-year follow-up diagnostic ultrasound revealed normal appearance of the supraspinatus tendon, its myotendinous junction and ACJ (Figure 3B, 4B).
MRA of Shoulder: Initial and 1-Year Follow-up. A: Initial MRA. Tear in the superior labrum at the biceps labral attachment (A-arrows) and surrounding inflammation (B-arrow) at initial evaluation B: MRA. Healing of glenoid labrum (Arrow A) and reduction in surrounding inflammation (Arrow B) at 1yr follow-up.
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An MRI with contrast was performed using a 3-tesla magnet and revealed a small focal tear in the superior labrum at the biceps labrum attachment (Figure 5A), with an intact biceps tendon. A follow-up MRI at one year revealed no discrete labral tears, minimal supraspinatus tendinopathy, and normal visualization of the ACJ (Figure 5B).