Bilateral anterior shoulder dislocations: A review of two cases and the relevant literature

Abstract

Bilateral shoulder dislocations are a rare occurrence. 1-6 The two humeral heads dislocate from the scapular glenoid fossa in the same direction (bilateral symmetric shoulder dislocations or BSSD) or in different directions (bilateral asymmetric shoulder dislocations or BASD). There are three subtypes of BSSD (posterior, 1,2 anterior, 3 and inferior 4). BASD are classified as anteroposterior (one side anterior and the other side posterior) 5 or anteroinferior (one side anterior and the other side inferior). 6 Dislocations are acute or recent when recognized in the 21 days from the trauma. After 21 days, dislocations are called chronic or old. Bilateral symmetric posterior shoulder dislocations are the most common type since Cooper in 1839 1 and Myenter in 1902 2 reported the first cases. The literature found less commonly bilateral symmetric anterior shoulder dislocations (BSASD). 7 We report two cases of BSASD, one acute and one chronic case, both after epileptic seizures. We discuss the epidemiology, etiology, mechanism of injury, treatment, and outcome features through an extensive literature review of 133 BSASD reported cases. 3,7-118 2 | CASE HISTORY 2.1 | Case 1 A 30-year-old male patient complained of bilateral shoulder pain at our ED. The patient woke up at night on the ground, a few minutes after falling from bed, but with no recollection of the fall. He had no prior history of epilepsy nor diabetes. An inaugural epileptic grand mal seizure was suspected. At admission, he presented with bilateral shoulder sulcus signs with an inability to rotate his arm internally (Figure 1). The neurovascular status was normal at both shoulders. Bilateral shoulder AP and Bloom-Obata views revealed bilateral subcoracoid anteromedial glenohumeral dislocation without associated fracture (Figure 2). Closed reduction of both shoulders was performed under general anesthesia. With the patient in the supine position,

Bilateral Shoulder Anterior Dislocation with Proximal Humerus Fracture After Seizure Attack Post Covid-19 Vaccine

“…The youngest patient was 20 years old [26] and the oldest was 48 years old [4] . All patients reported in the reviewed literature included our study were males which confirms the previous results of other studies showed predominance of men over female in having bilateral anterior dislocations [1,18] . Moreover, 78.5 % of the patients presented in table 1, were due to acute injuries which similar to the results of Diallo M et al [18] .…”

“…All patients reported in the reviewed literature included our study were males which confirms the previous results of other studies showed predominance of men over female in having bilateral anterior dislocations [1,18] . Moreover, 78.5 % of the patients presented in table 1, were due to acute injuries which similar to the results of Diallo M et al [18] . Moreover, forty-three percent of the patients with bilateral anterior dislocation had complications often bilaterally presented as fractures including proximal humerus, and isolated greater tuberosity fractures.…”

“…In our study, we reported 13 cases of bilateral dislocation caused after seizure episodes (Table 1). In other previous studies, the authors 69 cases of bilateral anterior dislocation because of seizures however, the same studies reported 125 cases of bilateral anterior dislocation because of trauma and accidents representing a ratio of trauma to seizure cause of about 2:1 [1,14,18] . Moreover, few cases of seizures caused after COVID-19 vaccine were reported in the literature review however, no was associated with fracture of shoulder dislocations [9][10][11] .…”

“…In general, both shoulders appear symmetrical, and diagnosis may be missed by physicians not familiar with similar cases. Because of the pathognomonic (symmetric square shoulder aspect) referring to bilateral flattened shoulders and inability to internally rotate either shoulder, it is rare to miss dislocations in trauma conditions however, in nontraumatic and seizures cases, it is highly possible to miss the dislocations [18] . Neglected cases of bilateral dislocations of the shoulder were reported in some previous studies which required surgical reduction with eventual internal fixation [16,29,30] .…”

“…The presence of an associated lesion often necessitates operative management. Displaced greater tuberosity fractures were managed by plate and screws with washers [18] .…”