Rehabilitative Sciences
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/32562
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Browsing Rehabilitative Sciences by Author "Clearfield, Daniel"
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Item Platelet Releasate and ESWT for Treatment of a Partial Supraspinatus Tear in an Adolescent Baseball Player(2024-03-21) Bibi, Yasser; Al-Khabbaz, Omar; Clearfield, DanielBackground: Rotator cuff injuries are a prevalent orthopedic concern, often arising from repetitive overhead activities, traumatic events, or age-related degeneration with the supraspinatus muscle being the most frequently injured. As the muscle responsible for initiating abduction of the arm, the supraspinatus is particularly susceptible to strain and tears, contributing to the majority of rotator cuff injuries. The incidence of rotator cuff tears in the general population is 5-30%, the prevalence of the condition is about 25% in people over age 65 and above 50% in individuals over age 80. Case Presentation: An 18-year-old right-hand dominant male baseball player who plays the catcher position presents to the clinic with right shoulder pain. The patient reports that they had a rotator cuff injury in his anterior shoulder area about 9 months prior which led to him sitting out of his previous season. On ultrasound imaging, the supraspinatus muscle showed a twenty-five percent partial tear on the bursal surface of the anterior aspect, with no retraction seen on dynamic exam. There was no other tendinosis or tear noted, with normal muscle appearance without any atrophy or fatty infiltration, or evidence of impingement with dynamic imaging. The ESWT was conducted before the Platelet Releasate injection procedure. With the patient in a supine crass position, 3000 total pulses at 15 MHZ were applied to the affected area using 2.6-3.6 bars of energy with a D-Actor C15 tip. The patient portrayed good tolerance to treatment, with a reported decrease in pain and improved range of motion. Following ESWT, a platelet releasate procedure was conducted on the right shoulder. On imaging, the patient’s supraspinatus muscle showed significant improvement in the tear, with only ten percent of the tear in the anterior supraspinatus still apparent (15 percent reduction total in the supraspinatus tear). There was evidence of acute supraspinatus tendinitis, with no impingement on dynamic testing. There was also some newly acquired bursitis in the subacromial bursa. There was no other noted tendinosis or tear, with a normal-looking muscle appearance. Conclusion: Generally, it can be difficult to highlight specifics and attribute them to the therapeutic effects of a treatment that facilitates various regenerative and healing properties. The main point of this case is to surface a less popular therapy compared to PRP: platelet releasate/ESWT and their therapeutic effects for MSK-related injuries. Platelet releasate paired with ESWT is a minimally invasive outpatient procedure and should be presented as a potential therapeutic treatment option to patients before considering invasive alternatives.Item Trigger Point Injections as a Potential First Line Therapy for Persistent Myofascial Pain Syndrome(2024-03-21) Srikalyani, Sathvik; Clearfield, Daniel; Patel, ArpanBackground Myofascial pain syndrome (MPS), characterized by pain from myofascial trigger points in skeletal muscles, often responds to conservative treatments. However, in this case, the patient's persistent symptoms resisted conservative methods but found relief only with trigger point injections. Using trigger point injections as the primary treatment method for MPS is unique. While trigger point injections are documented, their role as a first-line treatment for MPS is underexplored. This case reinforces the potential of trigger point injections for patients unresponsive to conventional treatments and underscores the importance of personalized management for myofascial pain. Teaching points in this case highlight the significance of clinical expertise in the diagnosis and the role of advanced diagnostic tools like ultrasonography, emphasizing meticulous diagnosis in cases where traditional treatments fall short. Case Summary A 58 year old male ex-Army Ranger presented with persistent bilateral posterior leg pain and tightness after failed conservative treatments such as massages, stretching, and NSAIDs for more than a year. A preliminary differential diagnosis included chronic exertional compartment syndrome, vascular claudication, as well as myofascial trigger points. Ultrasound-guided trigger point injections were administered, significantly reducing pain, increasing function, and improving their range of motion. This success highlights the efficacy of trigger point injections in treating MPS that resists conservative methods. Conclusion Literature on MPS primarily focuses on non-invasive treatments and explores trigger point injections as an adjuvant to other treatments. However, this case is different because it features a patient with chronic lower extremity MPS unresponsive to conventional therapies. The case challenges the traditional view that non-invasive methods suffice for MPS and highlights trigger point injections as a potential first-line treatment. For similar unresponsive MPS cases, future management should consider the early use of trigger point injections, particularly with ultrasound guidance for safety and precision. This case stresses the importance of individualized care, encouraging healthcare practitioners to explore alternative treatments when conventional ones fall short.