Nonreducible Shoulder Due to Acute Posterior Dislocation of the Long Head of the Biceps Tendon

Abstract

Posterior dislocation of the biceps tendon is a rare complication of high-energy shoulder trauma. Inability to successfully relocate an anterior shoulder dislocation caused by a highly traumatic mechanism should raise suspicion for this rare injury. Knowledge of this condition is important because it requires open surgical reduction and repair. We present a case of a surgically proven posterior dislocation of the biceps tendon complicating an acute anterior shoulder dislocation. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-four-year-old man presented to the Emergency Department following a high-speed motorcycle collision. Upon arrival, the patient’s symptoms included right shoulder pain and decreased range of motion. On physical examination, the humeral head was displaced anteriorly, resulting in loss of the normal contour of the shoulder. The entire right upper extremity was swollen. Sensation was intact throughout the axillary, radial, median, and ulnar distributions, and a 2+ radial pulse was noted at the wrist. Active and passive shoulder range of motion was limited, and additional attempts at assessing shoulder range of motion were not tolerated because of severe pain. Initial radiographs (Figs. 1-A and 1-B) of the right shoulder revealed an anterior glenohumeral dislocation with osseous fragments in the glenohumeral joint space. The humeral head was displaced medial and inferior to the coracoid process. Figs. 1-A and 1-B Anteroposterior radiographs of the right shoulder show anterior glenohumeral dislocation with many osseous fragments in the glenohumeral joint space. The humeral head is displaced medial and inferior to the coracoid process. Fig. 1-A Fig. 1-B Under moderate sedation, attempts to reduce the right shoulder dislocation were performed without success. Computed tomography (CT) of the shoulder (Figs. 2-A and 2-B) obtained after the attempted reduction revealed a persistent anterior dislocation with intra-articular fracture fragments and avulsion of the greater tuberosity. Subsequent magnetic resonance imaging (MRI) (Figs. 3-A through 3-D) showed massive rotator cuff tearing with complete tears of the supraspinatus, infraspinatus, and teres minor tendons. Their myotendinous junctions were retracted to the level of the …