Neglected Bilateral Anterior Shoulder Dislocation Following Epileptic Seizure: A Case Report and Literature Review

Raptis, Konstantinos; Koutserimpas, Christos; Alpantaki, Kalliopi; Kaiafas, Stefanos; Fandridis, Emmanouil; Bourlos, Dimitrios

doi:10.2739/kurumemedj.ms661008

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…MRI is also recommended in most cases to evaluate for other pathologies such as anterior or inferior glenoid labrum tears (Bankart lesions), humeral head injuries (Hill-Sachs lesions), rotator cuff tears, etc. Definitive treatment can range from simple nonoperative management in a sling followed by physical therapy, to shoulder arthroscopy and labral repair or rotator cuff repair, to arthroscopic or open stabilization using bone grafting or Latarjet [2,6,15,[17][18][19][20]. Complications of dislocation and surgical intervention can include neurologic injury, shoulder stiffness or loss of motion, avascular necrosis [15,18], degenerative joint disease, and recurrent instability.…”

Section: Discussionmentioning

confidence: 99%

“…In both of our cases, a his-tory, physical exam, and imaging were important factors in making a diagnosis, and treatment generally consisted of antiepileptic medications and orthopedic consultation. Orthopedic intervention may vary widely because of the heterogeneous nature of the injuries, but treatment may be operative or nonoperative and may include internal fixation or a multitude of strategies aimed at restoring stability to an unstable joint [2,6,15,[17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

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Two Cases of Anterior Shoulder Dislocation and Fracture Secondary to Generalized Tonic-Clonic Seizure

Dao,

Veedu,

et al. 2024

Case Reports in Orthopedics

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Dislocation of the glenohumeral joint secondary to generalized tonic-clonic seizures is well documented in the medical literature, with posterior dislocation being most commonly described. Still, these occurrences tend to be rare and affect a minority of patients, and fractures associated with dislocations after seizures are even less common. As such, the management of these injuries tends to be quite varied, and there is a paucity of documented cases in the literature. Here, we would like to present two rare cases of anterior shoulder dislocation secondary to seizures, with one patient also sustaining a fracture of the proximal humerus. We would also like to discuss the management and outcomes that have been achieved, since these cases tend to occur in a small number of epileptic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Two Cases of Anterior Shoulder Dislocation and Fracture Secondary to Generalized Tonic-Clonic Seizure

Dao,

Veedu,

et al. 2024

Case Reports in Orthopedics

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“…O'Connor-Read et al [ 15 ] postulated that anterior shoulder dislocation during a seizure arises not from the seizure itself, but rather from the trauma that occurs when the shoulder contacts the ground upon falling. However, Raptis et al [ 11 ] reported a case of chronic BSASD occurring after a patient experienced seizures without any fall or other traumatic injury. Further information regarding the position of the patient's arms during the seizure and details on any trauma occurring due to the seizure would thus allow valuable insight into the exact mechanism of BSASD resulting from seizure activity.…”

Section: Discussionmentioning

confidence: 99%

Chronic Bilateral Symmetric Anterior Shoulder Dislocation Secondary to Seizures in Chikungunya Encephalitis

Budhoo¹,

Mohammed²,

Baiju³

et al. 2022

Cureus

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Bilateral shoulder dislocations are a rare occurrence and can be categorized as either symmetric (both humeral heads dislocate in the same direction) or asymmetric (wherein the humeral heads dislocate in different directions). Shoulder dislocations may be overlooked if they are the result of systemic injury; if diagnosed >21 days after occurring, they are considered chronic dislocations.We describe the case of a 31-year-old male who presented with an eight-week history of bilateral shoulder pain. His onset of pain coincided with a seizure secondary to Chikungunya encephalitis. Clinical and radiological examination demonstrated bilateral symmetric anterior shoulder dislocation with associated greater tuberosity fractures and extensive callus formation bilaterally. Open surgical management was performed first on the left shoulder via the deltopectoral approach. The callus was removed, the greater tuberosity fragment lifted off, reattached to the original position, and held in place with sutures and proximal humeral locking plates. The right shoulder was reduced six weeks after the left shoulder due to patient preference; the reduction utilized the same approach as with the left shoulder. Post-operatively the patient was immobilized, and physiotherapy commenced. He achieved a satisfactory range of motion four months post-operation.Physicians should be cognizant that shoulder pain after a convulsive seizure may signify shoulder dislocation. Thorough clinical and radiological examinations are warranted in such an instance. There exists no consensus on the treatment of chronic shoulder dislocations, but it is recommended that closed reduction only be attempted up to six weeks post-dislocation due to the high risk of iatrogenic fractures and neurovascular damage beyond this time.

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“…On review of the literature published in the English language there are eleven previous reports of chronic bilateral anterior glenohumeral dislocation ( Table 2 ). Of these eleven, four were treated non-operatively [ 9 , 10 , 11 , 12 ] and no closed reduction was attempted, four were treated with open reduction alone [ 13 , 14 , 15 , 16 ], two were treated with successful closed reduction and ORIF of the concurrent greater tuberosity fractures [ 17 , 18 ] and one was treated by closed reduction alone [ 19 ].…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Coracoid Osteotomy, Greater Tuberosity Take Down and Latarjet Procedure for Missed Bilateral Locked Anterior Shoulder Fracture-Dislocations in a Young Man

Jones¹,

Clough²,

Kantak³

et al. 2021

JOCR

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Introduction:It is rare to see chronic bilateral anterior fracture-dislocations as a result of seizure, and we present a case of this type and review of the literature. Despite the signs and symptoms of shoulder dislocation being well documented, and X-ray imaging being good at identifying such pathology, there are a few cases in the literature of missed or chronic shoulder dislocation (a shoulder that has been dislocated for more than 3 weeks) but these are extremely rare. Our case represents the first example of chronic bilateral locked anterior fracture-dislocations requiring open reduction and coracoid osteotomy with GT takedown to gain adequate exposure and allow soft tissue release to facilitate joint reduction. No other case has used anchors to achieve GT fixation, and our patient is the youngest published case with such pathology. Case Report: A 16-year-old boy presented to the emergency department with reduced range of movements in both shoulders. Six weeks prior he had suffered an epileptic seizure. X-rays confirmed bilateral anterior shoulder dislocations with displaced greater tuberosity (GT) fractures. Staged open reduction was performed in the right and then left shoulder. Coracoid osteotomy with takedown of the malunited GT fracture was needed to assist with gradual soft tissue contracture release and a successful relocation. Latarjet procedure was then performed and the GTs were fixed using rotator cuff anchors. At 6 months post-operation, on the right side, he achieved forward flexion to 150o and abduction to 120o. On the left side, forward flexion was 110o and abduction was 90o. X rays showed satisfactory maintenance of the reduction without signs of avascular necrosis of the humeral head. Conclusions: Surgical management of this injury in this way is effective and achieves good results in the first 6 months of follow up. A high index of suspicion should be employed for this injury in post-ictal patients with shoulder pain. Early mobilization and

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Neglected Bilateral Anterior Shoulder Dislocation Following Epileptic Seizure: A Case Report and Literature Review

Cited by 6 publications

References 15 publications

Two Cases of Anterior Shoulder Dislocation and Fracture Secondary to Generalized Tonic-Clonic Seizure

Two Cases of Anterior Shoulder Dislocation and Fracture Secondary to Generalized Tonic-Clonic Seizure

Chronic Bilateral Symmetric Anterior Shoulder Dislocation Secondary to Seizures in Chikungunya Encephalitis

Coracoid Osteotomy, Greater Tuberosity Take Down and Latarjet Procedure for Missed Bilateral Locked Anterior Shoulder Fracture-Dislocations in a Young Man

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