i have noticed that shoulder subluxation occurred after surgical fixation for fracture proximal humerus either open by plating or closed by k-wire fixation.I have no clear explanation
My experience has been inferior subluxation most commonly. This is due to Injured and poorly activating muscle. All have resolved with deltoid exercises very quickly.
Subluxation of the shoulder can be caused by the above mentioned neurological complications, but also can be the result of:
1. Mal-position of the head following the fixation either in varus, posterior rotation or impaction into the metaphysis
2. Post-traumatic or post-op haematoma which is "filling" the joint and the head appears in subluxed position.
3. Post-traumatic or post-op muscle "shock" and weakness of it
4. Joint to be supported in an incorrect way following surgery (collar and cuff for example allows gravity to act and makes all the above more evident)
5. Finally age plays a role to exaggerate the picture due to the presence of weaker muscles
Inferior subluxation of the humeral head can occur after shoulder trauma or surgery. Its incidence varies. The reported incidence after rotator cuff repair is10%, after fracture of the proximal humerus (42%), and after prosthetic humeral head replacement (60%). It is most likely due to transient neuropraxia of the axillary nerve. Fortunately, it resolves by 6 weeks in most patients and no ong-term problem of subluxation remains. Usually, early active exercises and a sling when not exercising-is effective
1. Mechanical : orientation from rotation/flexion/extension of head resulting in incongruous joint. Excessive Ante or retroversion. Haematoma or other space occupying body.
As vacuum suction or adhesions- cohesion of shoulder joint is one of stabilising factor of an otherwise unconstrained shoulder joint, could the loss of these features post trauma contribute to subluxation.
Some deltoid weakness may be seen post-operatively. Usually resolves - on the assumption that it is neuropraxia and you are confident axillary nerve has not been damaged/trapped intra-operatively.