Arthroscopic findings in luxatio erecta of the glenohumeral joint: case report and review of the literature.

Abstract

We report the case of an inferior glenohumeral dislocation of the shoulder in which arthroscopic assessment showed an extensive detachment of the labral-biceps tendon complex (Bankart and superior labrum anterior posterior [SLAP] lesions). We sought to review the literature to compare our findings with the reported lesions in this type of shoulder dislocation. A young patient presented with an inferior dislocation of his right shoulder (erect dislocation) after having sustained a motorcycle accident. Conventional radiographs revealed the humeral shaft parallel to the scapular spine and an anteroinferior position of the humeral head with a large avulsion of the greater tuberosity. Preceding arthroscopy showed a complete detachment of the anterior labrum and ligament complex (SLAP lesion). After open reduction and internal fixation of the greater tuberosity, the capsulolabral complex was reduced and securely fixed with three bone anchors at the glenoidal rim. The patient recovered well reaching full shoulder function after 5 months and regaining the former sports activity level within 9 months after surgery. Arthroscopy identified the location and extent of an important labral detachment that, in combination with the stability testing under anesthesia, proved the need for a labral refixation. The literature regarding reported pathology in inferior glenohumeral dislocation is reviewed, and the additional information on associated soft-tissue lesions by means of arthroscopy are discussed. No prior case of arthroscopic assessment in inferior glenohumeral dislocation of the shoulder has been reported. Recognizing the extent and site of accompanying labral detachments contributing to the instability of the joint may enhance our knowledge of the full pathology in these dislocations and thus allow an adequate surgical treatment.