Recurrent latissimus dorsi enthesopathy in a professional cricketer: A diagnostic challenge and return to sport with platelet-rich plasma therapy

Chronic scapular pain in overhead athletes often eludes diagnosis due to overlapping clinical presentations. This report describes a rare chronic grade 2 tear at the scapular attachment of the latissimus dorsi in a 20-year-old professional spin bowler. Symptoms remained refractory over a 14-month period despite conservative management. Dynamic ultrasound identified a partial tear, corroborated by magnetic resonance imaging (MRI) findings of focal muscle edema and subtle bone marrow changes at the enthesis. Ultrasound-guided dry needling and platelet-rich plasma injection achieved meaningful symptomatic relief (Visual Analog Scale 3/10) and full return to competitive cricket within 8 weeks. Accurate diagnosis required a high index of clinical suspicion, expert anatomical knowledge of the latissimus dorsi’s scapular attachment, and proficient musculoskeletal sonography. Ultrasound and MRI provided complementary diagnostic information – ultrasound enabling real-time dynamic assessment and procedural guidance, while MRI delineated deeper structural involvement and bone marrow changes. This case supports the role of image-guided regenerative intervention in refractory sports enthesopathy.