Wednesday, January 18, 2012
Lyme Disease as a Cause of Supraspinatus tendinitis
Coulon CL, Landin D., Phys Ther. 2012 Jan 12. [Epub ahead of print]:
Source C.L. Coulon, PT, Peak Performance Physical Therapy, 11320 Industriplex Blvd, Baton Rouge, LA 70809 (USA).
BACKGROUND AND PURPOSE: /b>Supraspinatus tendinopathy is a common cause of shoulder pain seen in overhead athletes, but to our knowledge no published cases present Lyme disease as the underlying cause of tendinopathy. Lyme disease is diagnosed primarily by clinical signs and symptoms and then supported by laboratory tests including western blot and enzyme-linked immunosorbant assay (ELISA). This case demonstrates the importance of a physical therapist's input and clinical role in reaching the correct diagnosis in an athlete with Lyme disease, who presented with a diagnosis of rotator cuff impingement and tendinitis.
CASE DESCRIPTION: /b>A 34-year-old male tennis player presented to physical therapy with right shoulder impingement and tendinitis diagnosed by an orthopedic surgeon. He was unable to participate in sporting activities due to impairments in strength and pain. Initial examination revealed distal supraspinatus impingement and tendinopathy.
OUTCOMES: /b>The patient was not progressing with commonly accepted interventions and began to have "arthritis-like" shoulder pain in the uninvolved left shoulder. Suspicious of an underlying condition, the physical therapist informed the physician of the patient's updated status and referred to the physician to discuss the current symptoms in therapy. After testing, the patient was diagnosed with chronic Lyme disease and underwent antibiotic therapy.
DISCUSSION: /b>Many active patients spend time in the outdoors increasing their risk of exposure to a vector for Borrelia burgdorferi. Physical therapists spend a larger portion of time with patients than other health care professionals, and due to this extended contact and musculoskeletal knowledge are able to recognize atypical musculoskeletal disorders or musculoskeletal manifestations of unusual pathologies including Lyme disease.
PMID: 22247404 [PubMed - as supplied by publisher]