Missed bilateral anterior fracture dislocations of the shoulder

Abstract

A 65-year-old lady was referred to us by the rheumatologists. She had been sent by her GP after 8 months of bilateral shoulder pain. Before this she had been asymptomatic until she fell from a bus whilst on holiday abroad, landing on both her outstretched arms. At that time she was taken to the local hospital where she was told that there was no significant damage done and sent back to her hotel. She was not X-rayed at any stage. She subsequently sought her own GP’s advice as her shoulders were very bruised and painful to move. She was advised to rest and referred for a 6-week course of hydrotherapy. After this, the situation did not improve and she noticed that her deltoid muscles were quite wasted and her arms were getting weaker. There had also been loss of sensation in the median nerve distribution of her right hand since the accident. On examination she had marked wasting of both deltoids with reduced sensation as tested by pin prick. She had no glenohumeral movement in either shoulder and severe pain on attempting this. She also had signs of a right median nerve palsy. X-Rays revealed bilateral fractures of the greater tuberosity with anterior dislocations (Figures 1 and 2). She was admitted electively for open exploration of the right shoulder first. At operation, it was impossible to reconstruct a very osteoporotic humeral head with a cleavage fracture of the greater tuberosity, so a hemiarthroplasty was performed (Figure 3). The result was a stiff but relatively painless shoulder and 6 months later she underwent the same procedure on the left side (Figure 4). She still however has median nerve damage on the right side.