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Penn plays Virginia Commonwealth and Richmond at the Levy Tennis Pavilion Ekaterina Kosminskaya Credit: Kira Simon-Kennedy , Kira Simon-Kennedy

Ekaterina Kosminskaya knew that something was wrong.

She just didn’t want to know what.

So despite the pain that came whenever she lifted her right arm, the senior avoided medical tests for a semester, instead trying physical therapy, weight training — anything to get back on the tennis court where she won 67.4 percent of her matches for the Quakers over the past three years.

Her shoulder did not respond, though, and an MRI exam eventually confirmed everyone’s fear: Kosminskaya had a tear in her rotator cuff.

While surgeons can repair the tendon — Kosminskaya has her trepidations — even the best cannot restore her tennis career.

The Penn senior has battled shoulder problems since her early teenage years, although she rarely missed matches. The more she played, the more she ached. Continued overuse (rather than an acute “pop”) led to the tear.

Choosing to come to Penn instead of playing professionally four years ago was already an acknowledgement that injuries had derailed her elite potential. Still, she held out hope.

“Now it’s out of the question to go pro,” said Kosminskaya, the 2006-07 Ivy Player of the Year.

“This injury is too serious. Even after the surgery, which will fix the tendon,” she added, “I still have problems with other parts of the shouder. Like the shoulder blade which, every time I move backwards, cracks badly.”

Her shoulder hurts when she sleeps, it hurts when she goes about her day — “I can try to avoid pain, but sometimes I feel I need to raise my arm” — and it hurts too much to even try serving or hitting an overhead.

“I feel limited,” Kosminskaya said. “I have some other feelings sometimes — I’m upset, sometimes maybe I think it’s good, I have more time for myself … but I guess that’s occasional. One thing I feel every day is limited.”

Junior Alexa Ely, who lives with Kosminskaya and has been playing at the No. 1 singles spot in her stead, has noticed the change in her former teammate’s demeanor.

“It’s been a huge, difficult change for her,” she said. “She’s always telling me how much she misses tennis and the team and the girls.”

After her MRI, the focus shifted to getting her healthy while she still has access to Penn’s top-notch doctors and facilities — which, first-year head coach Sanela Kunovac said, “is exactly what the University should do for somebody who’s given so much early in her career at Penn, who’s achieved so much.”

Doctors at Penn Medicine and elsewhere have advised Kosminskaya to get the surgery. But just as she is right-handed in tennis, the former tennis star is right-hand dominant in her daily life, and the procedure would render her right arm immobile for about six weeks.

“I cannot treat it any other way,” Kosminskaya said. “The surgery is highly recommended. And I know that I need it and I want it, but at the same time, it’s too inconvenient, so I’m still thinking about it.”

Waiting until after graduation might be more tempting if not for questions about health-insurance coverage. She has been told that the operation would cost around $15,000 — a hefty pricetag for someone who plans to head to grad school.

As Kosminskaya prepares for a future without tennis (the senior plans to pursue a master’s degree in international development) the Quakers, who are 2-4 in the spring season, have been adjusting to life without their star.

Kosminskaya cheers on her former teammates at home matches, but that’s about all she can do.

Though Penn looked into making her an assistant coach, that addition would have given the program more coaches than the NCAA permits.

“It’s been a huge loss for the team,” Ely said. “She put the name of the school out there with her success. She was someone that I looked up to in practice. She would always come and work really hard. She’s just a beautiful, smart player to watch.”

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