Clinical Sciences/Health Conditions
Brian Malave, MD
Resident Physician
Mount Sinai Department of Human Performance and Rehabilitation
New York, New York, United States
Michael Harbus, DO
Assistant Professor
Mount Sinai Department of Human Performance and Rehabilitation
New York, New York, United States
Early-to-moderate glenohumeral osteoarthritis with associated biceps tenosynovitis and rotator cuff tendinosis. A 65-year-old woman presented with a 20-year history of left shoulder pain with progressive functional limitation. Exam showed positive Hawkins, Neer, and Speed’s tests with restricted active range of motion. X-ray demonstrated mild–moderate glenohumeral osteoarthritis with subchondral cysts. MRI demonstrated partial to near full-thickness cartilage loss of the humeral head and glenoid with chondral fissuring, subchondral cystic change, synovitis, and degenerative superior labral changes. MRI also noted biceps tenosynovitis and tendinosis of the supraspinatus, infraspinatus, and subscapularis without full-thickness rotator cuff tear or cuff tear arthropathy.
Ultrasound-guided biceps tendon sheath corticosteroid injection produced partial pain relief for approximately two weeks without improvement in range of motion or function. Due to persistent symptoms, ultrasound-guided platelet-rich plasma (PRP) was injected intra-articularly into the glenohumeral joint with additional PRP to the biceps tendon sheath. After PRP, the patient reported approximately 85% pain reduction. Documented gains included forward flexion improving from ~130–140° to full flexion and internal rotation improving from ~30° to ~90°. She regained the ability to perform push-ups. No complications were reported.
Nonoperative options for glenohumeral osteoarthritis are limited when corticosteroids provide only transient benefit. PRP may modulate synovial inflammation and periarticular pain generators, reducing pain and enabling restoration of movement and function. This case emphasizes objective range-of-motion and activity improvements – outcomes less commonly highlighted in shoulder osteoarthritis PRP reports – supporting consideration of PRP within a regenerative rehabilitation framework for selected patients with non–end-stage degenerative disease.
PRP following limited corticosteroid response was associated with substantial pain relief and meaningful range-of-motion and functional improvement in early-to-moderate glenohumeral osteoarthritis. Limitations include single-patient design and limited follow-up; prospective studies should evaluate durability, standardized PRP protocols, and patient selection.
