Bilateral Traumatic Anterior Dislocation of Shoulder – A Rare Entity

What to Learn from this Article?

1.Presentation and management of bilateral traumatic anterior shoulder dislocation?

2.Unique mechanism of injury for this rare phenomenon?  


Case Report | Volume 3 | Issue 1 | JOCR Jan – March 2013 | Page 23-25


Authors: Yashavantha Kumar C [1],  Nalini K B [1],Lalit Maini [2], Prashanth Nagaraj [1]

[1] MSR Medical College, Bangalore-560054, INDIA.
[2] Maulana Azad Medical college and associated Lok Nayak Hospital, New Delhi,India.

Address of Correspondence: Dr Yashavantha Kumar C. No 20, Sri Tiru Nivas, Lotte Golla Halli, Near Gandhi school, RMV II STAGE, Bangalore -94. India. Email: kumyashwanth@gmail.com


Abstract

Introduction: Bilateral shoulder dislocation are most commonly posterior type. These are most commonly due to seizure disorder and electrocution. Anterior shoulder dislocations occurring bilaterally without any predisposing factors are very rare. These types of injuries are due to trauma with a unique mechanism of injury. To best of our knowledge there are only few cases of similar kind are reported in literature. We hereby report a interesting case of posttraumatic, bilateral  anterior dislocation of shoulder without  associated fracture in a 45 old women without any predisposing pathoanatomy.

Case Report:  A 45-year-old women presented to casualty with sudden onset of  pain and restriction of movement in both shoulders fallowing trauma. Immediately post trauma she had severe pain and restriction of both shoulders.  On examination arms were abducted and externally rotated. Bilateral shoulder movements were painful and restricted . There was loss of round contour of shoulder with increased vertical diameter of axilla anteriorly. Radiological examination revealed bilateral anterior dislocation of the shoulders without any associated fractures. Closed reduction done by Milch technique after intraraticular lignocaine injection.  MRI of bilateral shoulder showed no pathological lesion. Both shoulders were immobilized with a shoulder immobilizer for three weeks.

Conclusion: Most of the bilateral shoulder dislocations are posterior type seen in seizure disorders. Bilateral traumatic anterior shoulder dislocations are rare and are seen as a result of unique mechanism of injury. In our case patient had a fall on her  elbows causing forced extension. If diagnosed and treated promptly completely normal function of the shoulders can be restored.

Keywords: Bilateral; dislocation; traumatic; shoulder


 

Introduction
Shoulder is the most commonly dislocated joint in the body because of its mobility. Bilateral shoulder dislocations are usually posterior type and are almost pathognomonic of seizure disorder or electrocution. Though anterior dislocation of shoulder is commonest bilateral simultaneous dislocation is very rare[1-7]. To best of our knowledge there are very few cases reported in literature [2]. We hereby report a case of posttraumatic, bilateral anterior dislocation of shoulder without associated fracture in a 45 old women.

Case Report
A 45-year-old women presented to Lok Nayak Hospital , New Delhi , India in august 2010 with sudden onset of pain and restriction of movement in both shoulders fallowing trauma. Patient slipped while walking downstairs and fell down over pointed elbows. Immediately post trauma she had severe pain and restriction of both shoulders. She had no history of seizure, epilepsy, previous shoulder dislocation or instability in other joints. On examination arms were abducted and externally rotated. Bilateral shoulder movements were painful and restricted (Fig. 1). There was loss of round contour of shoulder with increased vertical diameter of axilla anteriorly. Radiological examination revealed bilateral anterior dislocation of the shoulders without any associated fractures(Fig 2).
Closed reduction done by milch technique after intraraticular lignocaine injection. Post reduction radiographs showed congruent reduction (Fig.  3). MRI of bilateral shoulder showed no pathological lesion. Both shoulders were immobilized with a shoulder immobilizer for three weeks. Mobilisation with strengthening the rotator cuff and deltoid muscles started after three weeks.

Discussion
Majority of the bilateral shoulder dislocations are of posterior type most commonly seen during convulsion, electric shock or hypoglycaemic seizures. Posterior type is common in these conditions due to violent contractions of the muscles of the shoulder girdle [8-10]. Unlike posterior dislocations anterior type occur more commonly following significant trauma. Bilateral occurrence of anterior shoulder dislocation is rare because of the fact that one extremity takes the brunt of the impact. To best of our knowledge only three cases of bilateral anterior dislocations are reported in literature. In two of the three cases reported were sequential, one sided followed by contralateral side dislocation. In our case impact is same on both shoulders at the same time.
The mechanism of anterior dislocation is forced extension, abduction and external rotation of the arm. In our case mechanism of injury was forced extension as the patient fell on her pointed elbows. Mechanism of injury, systemic disease and associated fractures in various similar cases is depicted in table 1.
Croswell and Smith reported a case of bilateral anterior dislocation of the shoulder without any fractures in a bench-pressing athlete [11]. In an unusual mechanism of injury weight on the bar forced his arms into hyperextension in the mid-abducted position. The humeral shaft gradually pivoted on the bench and the humeral heads were slowly dislocated interiorly by the weight of the bar.
Sandeep Singh and Sudhir Kumar reported a case of sequential bilateral anterior dislocation in which the left shoulder dislocated first due to trauma followed by atraumatic dislocation of the right shoulder[12]. Sreesobh K V et al reported a case of sequential bilateral dislocation in a chronic alchoholic in which an atraumatic dislocation of the right shoulder is followed by traumatic dislocation of the left [7].
Closed reduction of both shoulder dislocation carried out under general anaesthesia by Milch manoeuvre [13]. Patient was immobilized with a shoulder immobilizer for three weeks. MRI of bilateral shoulder showed no other pathological lesion. Mobilisation with strengthening the rotator cuff and deltoid muscles started after three weeks. Six months after follow up patient had full range motion without any instability.

Conclusion
Bilateral anterior shoulder dislocation following a trauma is very rare occurrence. This type of dislocation involves a unique type of mechanism injury and in our case it was fall on pointed elbow causing forced extension.

Clinical Message

Bilateral anterior shoulder dislocations most commonly because of seizures. Traumatic bilateral anterior dislocations without any pathologic lesion are very rare with only few cases reported in literature. These types of dislocations are due to unique mechanism of injury. When diagnosed and treated promptly lead to restoration of completely normal shoulder joints.

References

1. Brown RJ. Bilateral dislocation of the shoulders. Injury 1984; 15:267–73
2. Turhan E, Demirel M. Bilateral anterior glenohumeral dislocation in a horse rider: a case report and a review of the literature. Arch Orthop Trauma Surg. 2008 Jan;128(1):79-82.
3. Lin CY, Chen SJ, Yu CT, Chang IL. Simultaneous bilateral anterior fracture dislocation of the shoulder with neurovascular injury: report of a case. Int Surg. 2007 Mar-Apr;92(2):89-92.
4. Bellazzini MA, Deming DA. Bilateral anterior shoulder dislocation in a young and healthy man without obvious cause. Am J Emerg Med. 2007 Jul;25(6):734.e1-3
5. Mofidi M, Kianmehr N, Farsi D, Yazdanpanah R, Majidinezhad S, Asadi P. An unusual case of bilateral anterior shoulder and mandible dislocations. Am J Emerg Med. 2010 Jul;28(6):745.e1-2.
6. Kalkan T, Demirkale I, Ocguder A, Unlu S, Bozkurt M. Bilateral anterior shoulder dislocation in two cases due to housework accidents. Acta orthop traumatol turc.2009 May-Jul;43(3):260-3.
7. Ashish Suryavanshi, Amber Mittal, Snehak Dongre, Neeti Kashyap. Bilateral anterior dislocation of shoulder with symmetrical greater tuberosity fracture following seizure. Journal of Orthopaedic Case Reports. 2012;1(1);28-31.
8. Cresswell TR, Smith RB. Bilateral anterior shoulder dislocations in bench pressing: an unusual cause. Br J Sports Med. 1998 Mar;32(1):71-2.
9. Litchfield JC, Subhedar VY, Beevers DG, Patel HT. Bilateral dislocation of the shoulders due to nocturnal hypoglycaemia. Postgrad Med J. 1988 Jun;64(752):450-2
10. Galois L, Traversari R, Girard D, Mainard D, Delagoutte, JP. Asymmetrical bilateral shoulder dislocation. SICOT Online Report. E024 2003 February 27th
11. Singh S, Sandeep K, Kumar R, Sudhir M. Bilateral anterior shoulder dislocation: a case report. European journal of emergency medicine. 2005 12(1): 33-35.
12. Sreesobh K V, Bennetchacko, Raffic: An Unusual Case of Bilateral Anterior Dislocation of Shoulder. J. Orthopaedics 2005;2(4)e6
13. Milch H. Treatment of dislocation of the shoulder. Surgery 1938;3:732-740.


How to Cite This Article: Yashwantha KC, Nalini KB, Maini Lalit, Nagaraj P. Bilateral traumatic anterior dislocation of shoulder, a rare entity. Journal of Orthopaedic Case Reports 2013 Jan-March;3(1):23-25.Available fromhttp://www.jocr.co.in/wp/wp-content/uploads/Jan-March-2013-Article-7.pdf


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