Platelet Releasate and ESWT for Treatment of a Partial Supraspinatus Tear in an Adolescent Baseball Player

Background: 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.