Ultrasound-guided PRP for coracoid syndrome: a novel case of conjoint tendon enthesopathy

Tendinopathy of the conjoint tendon (CjT), comprising the short head of the biceps brachii and coracobrachialis, represents an uncommon etiology of anterior shoulder pain. To our knowledge, this is the first documented case in which leukocyte-rich platelet-rich plasma (LR-PRP) was employed for its treatment. A 54-year-old male weightlifter presented with right shoulder pain that was refractory to conventional conservative management. Although magnetic resonance imaging revealed mild rotator cuff tendinopathy and acromioclavicular osteoarthritis, point-of-care ultrasound (POCUS) identified a hypoechoic lesion within the CjT accompanied by enthesopathy. An ultrasound-guided injection of LR-PRP resulted in complete symptom resolution within 1 month, with sustained improvement observed at the 12-month follow-up. Adverse effects were limited to mild, transient deep injection-site soreness noted on the first post-procedure day. Furthermore, ultrasound evaluation at 6 months demonstrated notable improvement in tendon morphology. This case underscores the importance of considering CjT tendinopathy in the differential diagnosis of anterior shoulder pain and highlights the critical role of POCUS in enhancing diagnostic accuracy and guiding targeted therapeutic interventions. LR-PRP may serve as a regenerative alternative to corticosteroid therapy, promoting tendon healing while avoiding corticosteroids side-effects. As a single case report, generalizability is limited, and conclusions should be interpreted with caution.