Supraspinatus tendon adhesions with shoulder stiffness after humerus anterograde nailing: a case report

Introduction: Humeral shaft fractures are common fractures and account for 3% of all long-bone fractures. Antegrade intramedullary nailing is an effective technique for treating these fractures. It provides good clinical outcomes and bone consolidation in over 90% of cases, but it carries risks of shoulder pain and stiffness. Case presentation: A 54-year-old right-handed manual laborer underwent antegrade intramedullary nailing for a transverse midshaft fracture of the left humerus. Postoperative X-rays showed excessive nail penetration of 1.5 cm into the humerus. Postoperatively, the patient developed significant shoulder pain and stiffness about passive anterior elevation. A supraspinatus tendon adhesion at the nail insertion site was diagnosed. Arthroscopic surgery was performed to release the adhesion, resulting in a marked improvement in shoulder mobility. At 24 months post-surgery, the patient’s shoulder function was significantly restored, with a Shoulder Subjective Value of 90% and a Constant score of 75. Discussion: The intra-articular nail entry point through the rotator cuff, the excessive sinking of the nail, and the postoperative immobilization caused the adhesion of the supraspinatus tendon onto the humeral head. Conclusion: This case underscores the efficacy of arthroscopic intervention in treating shoulder stiffness due to supraspinatus adhesion following antegrade nailing.