@XFactor posted:I'm so sorry that none of the medical professionals he saw at the time did not inform either you or your son that PRP is not indicated for much of anything in orthopedics, and especially not the shoulder. Lot of wasted time there, I'm sorry he had to go through that.
From having no effect on supraspinatus tears (but having worse adverse effects compared to saline) https://journals.sagepub.com/d...097?journalCode=ajsb to having no effect on patellar tendinopathy https://pubmed.ncbi.nlm.nih.gov/31038979/ same with lateral epicondylitis https://pubmed.ncbi.nlm.nih.gov/32103373/ and to top it all off, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214820/ which states: The results of this meta-analysis, which documents the very marginal effectiveness of PRP compared to controls, does not support the use of PRP as conservative treatment in orthopaedics.
As for the bitter truth that shoulder injuries don't heal themselves, well, they do - and surgery isn't always necessary, and some don't even out perform sham surgery where nothing is done (looking at labral repair for type 2 SLAP lesions, rotator cuff tears, and shoulder "impingement"). There are also a lot of people, including baseball players, that have "structural damage" and are fully functional and pain free.
This is why it's important to understand the patient, their expectations, and their relevant clinical findings and medical history. Not everyone needs imaging, but again that's based on symptoms/history/clinical findings.
Can surgery be an effective treatment? Absolutely 100%. Can PT be effective? Absolutely it can be. It's more nuanced than always needing imaging.
It's well known that there are abnormal findings on MRI in asymptomatic baseball players https://pubmed.ncbi.nlm.nih.gov/11798999/
Little Leaguers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826014/ whose discussion talks about: Asymptomatic rotator cuff tears and labral tears have been shown to be present in 21%-52% and 40%-48% of Major League Baseball pitchers
Draft picks https://pubmed.ncbi.nlm.nih.gov/26529676/
Adults https://onlinelibrary.wiley.co...1111/1756-185X.12476 whose conclusion states: Shoulder pathology is apparent in both symptomatic and asymptomatic shoulders and clinical symptoms may not match radiological findings. The cost burden of ordering MRI scans is significant and the relevance of the findings are questionable when investigating shoulder pain.
More adults https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710128/ whose conclusion states: Superior labral tears are diagnosed with high frequency using MRI in 45- to 60-year-old individuals with asymptomatic shoulders. These shoulder MRI findings in middle-aged populations emphasize the need for supporting clinical judgment when making treatment decisions for this patient population.
So ultimately, it's way more nuanced than you should always get imaging, or that it's needed. I'm not saying this person does or doesn't because I have no idea who they are. But if you MRI a professional pitcher who does not have shoulder pain and is fully functional, chances are you will find a rotator cuff tear, maybe a labral tear, etc... which, I'll take it back to my original point, it depends on the person in front of you, goals/expectations/beliefs, and relevant clinical findings.
But again these are my thoughts, any and everyone on here is well within their rights to say "Poo poo to that, I'm getting imaging no matter what," and that's absolutely your right to ask for that, and then it's the clinician's role to either explain it's not necessary, or if it is, say absolutely we're going to be getting imaging done.
I agree with many of your points and my sons ortho also mentioned most people 40+ who played any kind of overhead type sport has some sort of shoulder issue, including torn labrums.
Having said that I would absolutely get an MRI to at least have a base/starting point and to confirm a diagnosis and PT program. My son was diagnosed with a torn labrum which we decided to rehab to get him through the summer showcase circuit and if all went well he could avoid surgery. After 3-4 months of PT he was able to get back to playing at a high level. However, by the start of his Sr. year in HS the pain had returned and he was not able to continue playing. He ended up having surgery and 4 anchors put in. It was a long recovery process and his shoulder is still not 100% and probably never will be. The good news is he was healthy enough to come in and be the only freshman starter on his college team. I should also mention this was his non throwing shoulder.