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Summary
We present an unusual case
of bilateral sequential dislocation of the shoulder in a healthy
young male. Bilateral shoulder dislocations are rare; mostly
they are posterior caused by seizures or electrical
accidents.The reported bilateral anterior dislocations were
mostly associated with fractures. The one we present is a
bilateral anterior shoulder dislocation without any fractures.
Only two cases are reported in the literature so far.
Case Report
A 32
yr old healthy male presented to the orthopaedic casualty with
pain and inability to move both shoulders. He had a past history
of traumatic dislocation of the Right shoulder 6 months back.
He sustained the present injury under the influence of the
alcohol while carrying a bucket of water in his Right hand. He
felt pain and giving way of his right shoulder. In an attempt to
prevent a fall he tried to catch on to a post with his left
hand. Due to an abduction external rotation movement his left
shoulder also gave way.
The
clinical features were suggestive of a bilateral anterior
dislocation with no neurovascular injury. There were no
evidences suggestive of any generalised ligamentous laxity.
Radiographs confirmed the diagnosis of bilateral anterior
shoulder dislocation without any fractures.
Both the dislocations were
reduced one after the other by Kochers maneuver under sedation.
The reduction was accomplished successfully without difficulty.
Discussion
Bilateral dislocation of
the shoulder is a rare entity. Evidence from the literature
suggests that they are mostly posterior. According to Page et al
there are 26 reported cases of bilateral posterior dislocations.
Bilateral anterior dislocations are still more rare with only 8
reported cases in the literature. Out of these only 2 were not
associated with fractures.
Crosswell and Smith
reported a case of bilateral anterior dislocation of the
shoulder without any fractures in a bench-pressing athlete.
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.
Ours is also a case of sequential bilateral dislocation in which
an atraumatic dislocation of the right shoulder is followed by
traumatic dislocation of the left. The present case seems to be
the first of its kind in the literature.
Laurent Galiois et al and
Ioannis Tsionos et al have reported cases of combined anterior
and posterior dislocations.
References:
1. Page AE, Meinhard BP,
Schulz E, Toledano B. J Orthop Trauma. 1995; 9(6): 526-9.
2. TR Cresswell and RB Smith British Journal of Sports
Medicine, Vol 32, Issue 1 71-72, Copyright © 1998 by British
Association of Sport and Medicine
3. Singh, Sandeep; Kumar, Sudhir European journal of emergency
medicine 12(1): 33-35, Feb. 2005
4. Laurent Galiois et al SICOT online report E 024 Feb. 2003
5. Ioannis TSIONOS, Theophilos KARAHALIOS, Aristeidis H. ZIBIS,
Konstantinos N. MALIZOS Acta Orthopaedica Belgica 2004, N° 6
(Vol. 70/6) p.612
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