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Case Report: Platelet Rich Plasma Injection Used as Treatment of High-Grade Partial Pectoralis Muscle Tear in Division I Football Player

Guy W. Nicolette, MD, CAQSM*; Kristin Farrell, MS ATC

UF Sports Medicine, University of Florida, FL, USA

*Correspondingauthor:Guy W. Nicolette, Director, UF Sports Medicine Fellowship Program, Team Physician, UF Athletics, UF Student Health Care Center, University of Florida, FL, USA. Tel: +13522947440; Fax: +13523929625; Email: gnic@ufl.edu 

Received Date: 15 November, 2017; Accepted Date:05December,2017; Published Date: 12 December, 2017

Citation:Nicolette GW, Farrell K (2017) Case Report: Platelet Rich Plasma Injection Used as Treatment of High-Grade Partial Pectoralis Muscle Tear in Division I Football Player. Ann Case Rep: ACRT-150.DOI: 10.29011/2574-7754/100050

1.      Abstract

This case report describes a collegiate football player diagnosed with a high-grade partial pectoralis major tear,patient outcome after non-operative management using platelet-rich plasma injections, and a detailed description of the rehabilitation program used in this case.The purpose of this article is to describe a newer option for the management of this injury and give context to clinical decision-making in this setting.

2.      Keywords: Pectoralis Major Partial Tear; Platelet-Rich Plasma (PRP); Eccentric Strengthening



Figure 1: Axial MRI showing pectoralis tear.




Figure 2: Coronal MRI showing pectoralis tear.



Figure 3: Ultrasound long-axis to pectoralis showing tear.




Exercise

Wk 1

PRP

Wk 2

Wk 3

Wk 4

PRP

Wk 5

Wk 6

Wk 7

Wk 8

Wk 9

Wk 10

Wk 11

Wk 12

Pain Control

XXX

  

XXX

XX

X

  

XXX

XX

X

          

ROM

    

XXX

XXX

XX

  

XXX

XXX

XX

          

Isometrics

      

XX

XXX

    

XX

XXX

          

Scapular Stability

    

XXX

XXX

XX

  

XXX

XXX

XX

X

XX

X

X

X

PM Strength

                            

     Swim Ex

      

X

XX

    

X

XXX

          

      Int/Ext Rotation              

        

XX

      

XX

XXX

XX

XX

X

X

      Adduction

        

XX

      

XX

XXX

XX

XX

X

X

      Abduction

        

XX

      

XX

XXX

XX

XX

X

X

      D1/D2

        

XX

      

XX

XXX

XX

XX

X

X

Core Stability

      

X

XX

  

X

X

X

X

X

X

X

X

Eccentrics

                            

      Theraband

        

X

    

X

X

XX

XX

XXX

XXX

XXX

      Manual Resistance

        

X

    

X

X

XX

XX

X

X

X

      Pushup variations

      

X

X

    

X

XX

XXX

XX

XXX

XXX

XXX

      90/90 KB ER Hold

                  

X

XX

XX

XX

X

      Ball catch

                  

XX

XX

XXX

XXX

XXX

Stability

                            

      Rebounder

                

XXX

XXX

XXX

XX

XX

X

      Body Blade

                

X

XX

XX

XXX

XXX

XXX

      BoSu Ball

                

X

XX

X

XXX

XXX

XXX

Sport Specific

                            

      Heavy Bag

                      

X

XXX

XXX

      Sleds

                      

X

XXX

XXX

Weight Room

              

X

XX

XXX

XXX

XXX

XXX

XXX

X   Low Focus

XX   Moderate Focus

XXX   High Focus

 

Table 1: Weekly Rehabilitation Schedule.

 

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2.      Ball V, Maskell K, Pink J (2012) Case series of pectoralis major muscle tears in joint special operations task force-Philippines soldiers diagnosed by bedside ultrasound. J Spec Oper Med Winter12:5-9.

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5.      Zvijac JE, Schurhoff MR, Hechtman KS, Uribe JW (2006) Pectoralis major tears: correlation of magnetic resonance imaging and treatment strategies. Am J Sports Med. 34:289-294.

6.      Merolla G, Paladini P, Campi F, Porcellini G (2012) Pectoralis major tendon rupture. Surgical procedures review. Muscles Ligaments Tendons J2:96-103.

7.      Zeman SC, Rosenfeld RT, Lipscomb PR (1979)  Tears of the pectoralis major muscle. Am J Sports Med6:343-347.

8.      Roi GS, Respizzi S, Dworzak F (1990)  Partial rupture of the pectoralis major muscle in athletes. Int J Sports Med11:85-87.

9.      Wolfe SW, Wickiewicz TL, Cavanaugh JT (1992) Ruptures of the pectoralis major muscle. An anatomic and clinical analysis. Am J Sports Med 20:587-593.

10.  Ahmad Z, Brooks R, Kang SN, Weaver H, Nunney I,et al. (2013) The Effect of Platelet-Rich Plasma on Clinical Outcomes in Lateral Epicondylitis. Arthroscopy 29:1851-1862.

11.  Dragoo JL, Wasterlain AS, Braun HJ, Nead KT (2014) Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med42:610-618.

12.  A Hamid MS, Mohamed Ali MR, Yusof A, George J (2012) Platelet-rich plasma (PRP): an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol (ISCRTN66528592). BMC Musculoskelet Disord13:138.

13.  Cheatham SW, Kolber MJ, Salamh PA, Hanney WJ (2013) Rehabilitation of a partially torn distal triceps tendon after platelet rich plasma injection: a case report. Int J Sports Phys Ther8:290-299.

14.  Schepull T, Kvist J, Norrman H, Trinks M, Berlin G, et al. (2011) Autologous platelets have no effect on the healing of human achilles tendon ruptures: a randomized single-blind study. Am J Sports Med39:38-47.

15.  Mishra A, Woodall JJr, Vieira A(2009) Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med28:113-125.

16.  Dallaudière B, Lempicki M, Pesquer L, Louedec L, Preux PM, et al. (2013) Efficacy of intra-tendinous injection of platelet-rich plasma in treating tendinosis: comprehensive assessment of a rat model. Eur Radiol23:2830-2837.

17.  Mautner K, Colberg RE, Malanga G, Borg-Stein JP, Harmon KG, et al. (2013) Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. Pm R5:169-175.

18.  Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, et al. (2013) Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop37:1583-1589.

19.  Ferrero G, Fabbro E, Orlandi D, Martini C, Lacelli F, et al. (2012) Ultrasound-guided injection of platelet-rich plasma in chronic Achilles and patellar tendinopathy. J Ultrasound15:260-266.

20.  Nichols AW (2012) Two-year follow-up of injection with platelet-rich plasma versus corticosteroid for lateral epicondylitis. Clin J Sport Med22:451-452.

21.  Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA (2013)  Treatment of Partial Ulnar Collateral Ligament Tears in the Elbow With Platelet-Rich Plasma. Am J Sports Med 41: 1689-1694.

22.  Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K (2013)  Platelet-Rich Plasma Injections in the Treatment of Chronic Rotator Cuff Tendinopathy: A Randomized Controlled Trial With 1-Year Follow-up. Am J Sports Med 41: 2609-2616.

23.  Dallaudière B, Meyer P, Hummel V, Perozziello A, Peuchant A, et al. (2013) Efficacy of second intra-tendinous platelet-rich-plasma injection in case of incomplete response of the first injection: three-year follow up experience. Diagn Interv Imaging94:871-877.

24.  Kumar V, Millar T, Murphy PN, Clough T (2013) The treatment of intractable plantar fasciitis with platelet-rich plasma injection. Foot (Edinb)23:74-77.

 

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