Posterior dislocation fractures of the shoulder in seizure disorders—two case reports and a review of literature

Abstract

We present two patients with complaints of shoulder pain after an epileptic seizure. Both patients had a posterior dislocation fracture of the shoulder. After reviewing the literature the following conclusions can be drawn: (1) A posterior shoulder dislocation fracture is rare. (2) One should not underestimate the muscular forces in seizure disorders and be alert for dislocation fractures of the shoulder and/or other joints. (3) The diagnosis is frequently missed, but an axillary radiograph or a CT scan always reveals the fracture.

Seizure Presenting With Fracture at Onset –A Case Report

“…To diagnose compression fractures of the spine, index of suspicion should be high in the patient presenting with complaints of ill-localized back pain without any history of trauma or fall. Other potential sites of fracture-dislocations in seizure are facial bones, proximal humerous, distal radius and the ankle bones 7 .…”

Silent Witnesses in the Diagnosis of Epilepsy

“…Typically the shoulder is painful and held in internal rotation, with the most consistent fi nding being mechanical block to external rotation (Robinson & Aderinto 2005). The diagnosis is diffi cult; 50% of posterior dislocations are missed when the patient is fi rst assessed (Gosens et al 2000;Robinson & Aderinto 2005). In one series, 20 of 41 posterior dislocations were not seen on standard anterior-posterior and lateral Xray views (Hawkins et al 1987).…”

Shake Till You Break – Bilateral Neck of Humerus Fracture Post Seizure

“…Forceful muscular contractions as a result of convulsive seizures contributing to various types of fractures and dislocations have been reported; which includes the vertebras, hips, shoulders and jaw (Brackstone et al 2001;Cagırmaz et al 2015;Gosens et al 2000;Lasanianos & Mouzopoulos 2008;O'connor-Read et al 2007). Unilateral fractures may be caused by direct mechanical trauma, but convulsions occurring in epilepsy or electrocution are the most common cause of simultaneous bilateral fractures (Kristiansen & Christensen 1984).…”