Peak Performance Physical Therapy, 11320 Industriplex Blvd, Baton Rouge, LA 70809, USA.
Phys Ther. 2012 May;92(5):740-7. doi: 10.2522/ptj.20110220. Epub 2012 Jan 12.
Supraspinatus tendinopathy is a common cause of shoulder pain seen in overhead athletes, but there appear to be no published cases that 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 enzyme-linked immunosorbant assay (ELISA) and Western blot testing. 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 had a diagnosis of rotator cuff impingement and tendinitis.
A 34-year-old male tennis player was seen for physical therapy for 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.
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 the patient to the physician to discuss the current symptoms in therapy. After testing, the patient was diagnosed with chronic Lyme disease and underwent antibiotic therapy.
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.
冈上肌肌腱病是一种常见的肩部疼痛疾病，见于上肢过顶运动员，但似乎没有发表的病例将莱姆病作为肌腱病的潜在病因。莱姆病的诊断主要基于临床症状和体征，然后通过实验室检查（包括酶联免疫吸附试验[ELISA]和 Western blot 检测）来支持。本病例说明了物理治疗师在诊断莱姆病运动员时的重要性，该运动员最初被诊断为肩袖撞击和肌腱炎。
一名 34 岁男性网球运动员因右肩撞击和肌腱炎接受物理治疗，该病由骨科医生诊断。他因力量和疼痛受损而无法参加体育活动。初步检查发现远端冈上肌撞击和肌腱病。
该患者在接受常用干预措施后并未取得进展，且开始出现未受影响的左侧肩部“关节炎样”肩部疼痛。出于对潜在疾病的怀疑，物理治疗师将患者的最新状况告知医生，并将患者转介给医生讨论治疗中当前的症状。经检测，该患者被诊断为慢性莱姆病，并接受了抗生素治疗。
许多活跃的患者在户外活动时间较长，增加了感染伯氏疏螺旋体的风险。物理治疗师比其他医疗保健专业人员花费更多的时间与患者在一起，并且由于这种延长的接触和肌肉骨骼知识，能够识别不典型的肌肉骨骼疾病或不常见病理的肌肉骨骼表现，包括莱姆病。
