Late diagnoses of orthopaedic injuries after epileptic crisis are a matter of concern. The rarity of correlation between seizure and specific trauma incidences such as bilateral anterior shoulder dislocation, may lead to improper estimation of the patient's clinical state, wrong treatment and unpleasant complications. We report the rare case of an undiagnosed bilateral anterior shoulder dislocation in an epileptic young man of 25 years of age. The way of treatment is described as well as the treating alterations, if needed, because of the 3 weeks delay from injury. The article focuses on the reasons of the non-diagnosis at the first place and proposes a possible explanation for the mechanism of the injury. This is the second documented case of a missed bilateral anterior shoulder dislocation following a seizure and the first one that was treated not earlier than 3 weeks post injury. Although not a matter of routine, the high importance of radiographic control after seizure, in case of suspicion, is concluded. The etiology causing the injury shall not disorientate the doctors from the possible diagnoses.

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An undiagnosed bilateral anterior shoulder dislocation after a seizure: a case report

Background Although anterior shoulder dislocation is common in everyday practice in Emergency Departments, bilateral presentation is a rare entity. Objectives The aim of this article is to report two additional cases of this rare injury and to introduce a new mechanism that can produce it. We made an exhaustive review of the literature and found 68 cases in printed publications. Also, we analyzed the mechanism of injury and the presence of predisposing factors, and propose a new etiological-mechanical classification. Case Report One case occurred after a trivial fall, and the other was produced by a mechanism not previously reported: the patient pushed strongly forward, expecting a resistance and finding none, his arms kept the forward movement and the shoulders dislocated. Discussion This lesion has a bimodal distribution, affecting mainly men (70%) with a mean age of 33.5 years, whereas in women, the average age is 57 years. The most common cause is trauma (50%), followed by muscle contractions (37%) due to seizures of different causes (epileptic, hypoglycemia, toxic, or hypoxic) or electrocution. In 15.7% of the cases, the diagnosis of bilateral anterior dislocation was not acute ( Conclusion The bilateral anterior shoulder dislocation may not be as rare as previously thought and must be taken into account in emergency services. The authors propose a new etiological-mechanical classification. Also, the importance of radiologic diagnosis must be highlighted.

Bilateral Anterior Dislocation of the Shoulder: Review of Seventy Cases and Proposal of a New Etiological-mechanical Classification

A case of bilateral anterior glenohumeral dislocation in a middle aged horse rider was presented. The patient was an amateur rider who sustained the injury when the horse reared suddenly. The rider fell back from the saddle while holding the halter. The shoulders were dislocated by a violent traction when shoulders were in internal rotation and flexion in sagittal plane and slight abduction in coronal plane. To the best of our knowledge this case is the third glenohumeral dislocation by forward traction. A review of the literature is presented.

Bilateral anterior glenohumeral dislocation in a horse rider: a case report and a review of the literature.

Asymmetric bilateral shoulder dislocation involving a luxatio erecta dislocation.

Bilateral anterior dislocation of the shoulders is very rare. A 20-year-old man presented with bilateral anterior shoulder dislocation as a result of a diving incident. He complained of pain and restriction of movement in both shoulders with abducted and externally rotated arms. Radiographs revealed that the shoulders were dislocated. The patient was treated with closed reduction and was able to resume swimming 3 months later. To our knowledge, this is the first bilateral anterior dislocation of the shoulders during a backstroke swimming competition that was caused by this mechanism of injury. The rarity of this lesion and its uncommon mechanism prompted us to relate this observation.

https://link.springer.com/content/pdf/10.1007%2Fs10195-011-0176-5.pdf

Bilateral anterior dislocation of the shoulders at the start of a backstroke competition.

Sir, Unilateral traumatic shoulder dislocation is a common injury but bilateral shoulder dislocations are rare. The most frequently seen bilateral dislocations are posterior following convulsions. Bilateral anterior shoulder dislocation after trauma have rarely been reported. We found only 8 previously reported cases in the literature. We report a rare case of bilateral traumatic anterior shoulder dislocation and discuss the mechanism of injury.

Kailash L Devalia

Papers

Bilateral post traumatic anterior shoulder dislocation.