Abstract
Dislocation of the shoulder is the commonest of all large joint dislocations. Inferior dislocation constitutes 0.5% of all shoulder dislocations. It characteristically presents with overhead abduction of the arm, the humerus being parallel to the spine of scapula. We present an unusual case of recurrent luxatio erecta in which the arm transformed later into an adducted position resembling the more common anterior shoulder dislocation. Such a case has not been described before in English literature. Closed reduction by the two-step maneuver was successful with a single attempt. MRI revealed posterior labral tear and a Hill-Sachs variant lesion on the superolateral aspect of humeral head. Immobilisation in a chest-arm bandage followed by physiotherapy yielded excellent results. The case is first of its kind; the unusual mechanism, unique radiological findings and alternate method of treatment are discussed.
Highlights
Shoulder dislocations account to 45% of all large joint dislocations[1]
We present an unusual case of recurrent post-traumatic luxatio erecta that transformed later to the adducted position
Such a clinical presentation and recurrence of luxatio erecta have not been described in English literature
Summary
Shoulder dislocations account to 45% of all large joint dislocations[1]. Inferior dislocation of shoulder constitutes 0.5% of all shoulder dislocations[2,3,4]. Patient resting arm on table at less than 90deg ographs showed inferior dislocation of right shoulder with humerus locked in adduction in the infra-glenoid region. Two-step maneuver for reduction of inferior shoulder dislocation (Figure 3, 4, 5) Step 1 Patient is positioned supine under sedation or anesthesia. DetoFhrviegeemdurmoratiehndets-3estmrhaiaoetfitdrolioynalfwoethifptehticwhooun-mdesytheelerapunsmd aoanndetuthhveepro:othshutemroehrlaantledhreapalodassiiptsieolcentveo-df Demonstration of two-step maneuver: humeral head is levered anteriorly with one hand on the posterolateral aspect of the mid-shaft of the humerus and the other hand positioned over the medial epicondyle. DaFriemgmuiornenas4dtrdautciotinonofretwduoc-estsehpummaenreaul vhera:deixntteornthalergoletantoioidn of Demonstration of two-step maneuver: external rotation of arm in adduction reduces humeral head into the glenoid. There is axillary loading on a fully abducted arm and the humeral head is driven through the weak inferior glenoinjury and occult skeletal pathology revealed posterior labral tear and a bony defect on the superolateral aspect (Figure 7). At 14 weeks, he regained full range of motion and at last review at 2 years post-trauma, he was still asymptomatic
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