Restoring shoulder function after osteoporotic fracture using a novel double-coil rPMS protocol: A case report with functional and radiological follow-up.

BACKGROUND

Post-traumatic shoulder stiffness is a frequent complication following humeral fracture surgery, particularly in elderly osteoporotic patients. Even after radiographic fracture healing, persistent functional limitation may occur, especially in patients unable to complete structured postoperative rehabilitation. Osteoporosis further complicates rehabilitation due to bone fragility and the increased risk of re-fracture.

CASE REPORT: A 76-year-old woman with severe osteoporosis presented nine months after surgical fixation of a humeral head fracture (Neer one-part, treated with K-wires) with secondary shoulder stiffness, characterized by severe pain, functional limitation, muscle weakness, and sleep disturbances. Radiographs obtained at presentation confirmed fracture union without secondary displacement. A four-month non-invasive rehabilitation program based on a combined repetitive peripheral magnetic stimulation (rPMS) protocol, using a novel double-coil static applicator and a dynamic handheld applicator, was prescribed. After two months, marked clinical improvement was observed: pain intensity decreased from 9/10 to 1/10, muscle strength improved from 1/5 to 4/5, and sleep disturbances resolved. Serial MRI scans demonstrated a progressive reduction of bone marrow edema and complete resolution of intra-articular effusion, while functional testing confirmed near-complete recovery of shoulder function.

CONCLUSIONS

This case illustrates that a combined approach using the novel double-coil and handheld rPMS may represent a feasible non-invasive adjunct in the management of persistent postoperative shoulder stiffness in elderly osteoporotic patients. While clinical and radiological improvement was observed, causal inference remains limited in a single-case design, and these findings should be confirmed in future controlled studies.