Shoulder bursitis? Doctor suggested PRP as alternative therapy

[Stax]

Hi Rip,

I am a 31 year old male, and I have been struggling with a shoulder issue for the last 6 weeks. I have tried to power through it, but ultimately, that strategy failed. I took 2 weeks off, but that didn't help either.

A bit of history - I had a subluxation (shoulder popped out of its socket briefly and went back in) in the same shoulder almost 3 years ago, but haven't had an episode since. I had an MRI shortly after the subluxation, and luckily enough, my labrum is intact.

Fast forward until now, over the last 6 weeks, I have gotten two surgeon's opinions - one who wants to do surgery or a cortisone inject, and the other who has recommended physical therapy and PRP.

I have full range of motion, but I have a sharp pain in the front of my shoulder whenever I press overhead - this is most prominent when I am lowering the bar, and getting ready to press again.

I had an MRI (3T without contrast) a few days ago and here are the findings:

• Acromion is of type 3 hooked, the most anterior portion of the acromion has a hooked shape.
• Mild lateral sloping of the acromion
• No significant A-C osteoarthritis
• There is minimal increased signal intensity of the distal supraspinatous tendon with no tendon tear, keeping with tendinosis
• Localised cystic collection measuring 8.6 x 8.1 x 8.8 mm, located in the subacromial bursa, indenting the proximal supraspinatous tendon
• Minimal fluid in the subscapularis bursa
• Normal glenohumeral synovial recesses
• Normal infraspinatus and subscapularis tendons and muscles
• Normal long head of biceps tendon with no evidence of tendinitis
• Glenoid labrum is normal in signal and appears intact
• Normal marrow signal intensity

Impression

• Lateral stopping of the acromion
• Minimal tendinosis of the supraspinatous tendon
• Loculated cyst in the subacromial bursa, indenting the proximal supraspinatous tendon
• Minimal fluid in the subscapularis bursa

My questions are:

1. What rehab approach do you recommend?
2. Should I ramp up the NSAIDs? I have been taking them sporadically (when I'm in pain) until now
3. Is PRP worth a try?

Thanks Rip.

[Mark Rippetoe]

What surgery does he want to perform? A simple Mumford procedure?

[Stax]

What surgery does he want to perform? A simple Mumford procedure?

A subacromial decompression, also known as an acromioplasty.

[Mark Rippetoe]

An osteophyte will eventually chop a hole in your cuff tendon, but the surgery is not much fun. I'd wait as long as possible, and make sure your form is correct on your presses. Post a press video. Change to a close-grip bench too.

[Soule]

I’m curious to hear your opinion on PRP, Rip. Specifically, if you believe it is effective in speeding up reabsorbtion, or if it can help heal a herniated disc by some other mechanism?

[Mark Rippetoe]

I really haven't looked into it, but I don't know anybody who says it helped them.

[Soule]

I know two guys who had success with it for long term chronic shoulder pain. Not sure on the specifics of their injuries, but they swear it worked.

I haven’t met anyone who has had it done for a disc herniation.

[Mark Rippetoe]

At any rate, NEVER get a cortisone shot in your shoulder.

[Stax]

Will do, Rip. I'll post a video of my pressing forum when I'm in the gym next.

The cortisone shot is one thing I'm not considering at all.

I live in Dubai and doctors here are generally very quick to recommend surgery because of how easy insurance approves it.

For now, my plan is to press light everyday for 3 sets of high reps, gradually increasing the weight / reps, and supplementing with 3 sets of chin ups on the lat machine.

I will bench 3 times a week.

Hot / cold therapy on the shoulder after each workout.

Does that work, Rip?

[Stax]

Seems like Rip moved this thread.

Chris, if you don't mind, does this approach look okay to you?