Physiotherapy Rehabilitation for Shoulder Stiffness Following ORIF of Proximal Humerus Fracture: A Case Report

Abstrak

Background: Shoulder stiffness is a common complication following proximal humerus fracture, particularly in older adults who undergo postoperative immobilization after open reduction and internal fixation (ORIF). This condition may result in pain, reduced range of motion (ROM), muscle weakness, and impaired functional performance.
Objective: To describe the clinical outcomes of a physiotherapy rehabilitation program in an older adult with shoulder stiffness following ORIF for a proximal humerus fracture.
Methods: A case report was conducted in a 65-year-old male with right shoulder stiffness following ORIF for a closed proximal humerus fracture. Physiotherapy was initiated after postoperative immobilization and consisted of transcutaneous electrical nerve stimulation (TENS), active and passive ROM exercises, stretching, diaphragmatic breathing exercises, and progressive resisted exercise. Outcomes were assessed using the Numeric Rating Scale (NRS), Manual Muscle Testing (MMT), shoulder ROM measurements, and the Shoulder Pain and Disability Index (SPADI) over four treatment sessions.
Results: Movement pain decreased from 4/10 to 3/10, while tenderness decreased from 2/10 to 1/10. Muscle strength improved from MMT grade 2+ to 3−. Active shoulder flexion increased from 75° to 90°, active shoulder abduction increased from 75° to 87°, and passive shoulder abduction increased from 95° to 106°. Functional status improved, with the SPADI score decreasing from 65.00% to 57.69%.
Conclusion: The rehabilitation program was associated with improvements in pain, shoulder mobility, muscle strength, and functional ability. This case highlights the potential value of individualized physiotherapy rehabilitation for postoperative shoulder stiffness, even when treatment is initiated after a period of immobilization.