Prolotherapy For Golfing Injuries And Pain (End)
CASE REPORT 1
48-year-old male complaining of low back and neck pain. He is an avid golfer and has been playing a lot recently. His back pain has been an issue over the years and tends to come and go, with occasional flares. The last low back flare occurred while playing golf while “hardly bent over and then started to have extreme pain” in this low back. The pain has persisted. Regarding his neck, he was dragging his golf clubs recently and felt his hand tingling with right-sided neck and trapezius pain. An MRI of this cervical spine showed a ruptured disc. The neck tingling has gotten a little better but he is still bothered by neck pain and stiffness.
Past Medical History (PMH): No surgeries, no major illnesses.
Review of Systems (ROS): No other complaints.
Medications: Levothryoxine, Vitorin, Niaspan Exam: Vital signs: Temp 98.0, Blood pressure: 124/70, Height 6’1”, Weight 214, Pulse 66, Pulse oximetry 97% O2. Gait antalgic, lumbar forward flexion 80 degrees, extension 10 degrees. Straight leg raising negative bilaterally. Tender to palpation at PSIA, ilillumbar and sacroiliac ligaments bilaterally.
Cervical ranged of motion: right 50 degrees, left 40 degrees, restricted extension, flexion within normal limits, ear to shoulder 20 degrees bilaterally. Tenderness of cervical interspinous ligaments. Negative for muscular weakness or neurological signs in arms bilaterally.
Findings: Degenerative disc disease lumbar and cervical spine; lumbosacral sprain-strain, chronic; cervicothoraic sprain-strain, chronic.
Treatment and Outcome: The patient underwent a course of prolotherapy treatments, first to the lumbosacral spine, then to the cerviothoraic spine. After 4 treatments to the lumbosacral spine and sacro-iliac ligaments, the patient reports 95% improvement and is back to golfing. After 3 treatments to the cerviothoraic spine the patient reports 95% improvement. Motion testing shows increase in both lumbar and cervical range of motion.
CASE REPORT 2
60-year-old left-handed male complaining of right shoulder pain on and off for the past five years. He has been a golfer for many years, however he first noticed the pain while taking luggage off a train and also during weight training. In the past, his shoulder pain would go away but this time it has persisted. It has exacerbated to the point of waking him up at night and he has begun to feel it while playing golf during the follow-through phase of his swing.
PMH: No major illnesses or surgeries.
ROS: No other complaints.
Exam: Vital signs: Temp 98.4, Blood pressure 100/60; height 5’8-3/4; weight 184; pulse 76; pulse oximetry 96%. Right shoulder abduction to 150 degrees and slightly “sticky”. Postive active compression test at 0 and 30 (biceps and rotator cuff). Tenderness to palpation at supraspinatous anteriorly and at transverse humeral ligament. No xrays or MRI’s to review.
Findings: Rotator cuff tendonitis/tendonosis with developing adhesive capsulitis; and sprain of transverse humeral ligament.
Treatment and Outcome: Patient began prolotherapy treatment to right shoulder. He was also educated on shoulder exercises to increase range of motion and advised to do them three times daily. After three prolotherapy treatments he reports 90% improvement, and no pain while golfing. Range of motion was tested and back to abduction of 180 degrees.
CASE REPORT 3 (Note: this patient is not a golfer but noted here because of SLAP lesion improvement after treatment.)
62-year-old male complaining of left shoulder pain, aggravated after a fall. Pain was so severe at one point he could hardly move the shoulder and it became frozen. He has been undergoing physical therapy and improved his range of motion by 80%, but still feels some restriction, and also continual pain in the shoulder which he describes as being like “a toothache.” He has seen several other physicians including a neurologist and orthopedic surgeon. Neck origin was considered but ruled out. Patient complains of severe limitations of activities of daily living secondary to pain and restricted range of motion in this shoulder.
PMH: No surgeries, elevated cholesterol controlled with diet, no major illneses.
ROS: No other complaints.
Exam: Vital signs: Temp 97.8, Blood Pressure 108/64, Height 6’3”, Weight 188, Pulse 89, Pulse oximetry 98% O2. Left shoulder exam shows abduction 160 degrees. Positive active compression test (biceps positive). Tenderness at ACJ. Apley scratch restricted at upper pole. Restriction with internal rotation.
MRI of left shoulder: (1) No rotator cuff tear; (2) Slap lesion; (3) Downsloping acromion, type 3; (4) Arthrosis of the acromioclavicular joint; (5) Impingement; (6) Anterior rotator interval capsulitis and sprain; (7) Anterior and posterior capsulitis and sprain; (8) Fluid in the shoulder joint; (9) Fluid in the subscapularis bursa; (10) 2mm cyst vs. varicose vein of the glenoid notch; (11) Two 2mm cysts in the humeral head which are considered to be benign simple cysts.
Findings: (1) Left shoulder adhesive capsulitis, resolving with physical therapy; (2) Bicipital/rotator cuff tendonitis/tendinosis; (3) SLAP lesion; and (4) Degenerative joint disease left shoulder.
Treatment and Outcome: The patient continued with his course of physical therapy and concurrently underwent a course of prolotherapy treatments. After 5 prolotheapy treatments, he reports restoration of range of motion, no pain, and overall rates his improvement at 95%. Range of motion was tested and found to be normal. MRI was subsequently repeated and as follows
Followup MRI: Normal signal intensity and size of supraspinatous muscle and tendon. Infraspinatus, subscapularis and teres minor muscles reveal no tear or sprain. There is no subacromial or subdeltoid buras effusion and superior and inferior glenoid labrum are instact. The humeral head is smooth but there is type 3 acromioclavicular joint spurring causing mild acute supraspinatous muscle impingement; no tear or additional abnormalities.