Bilateral Luxatio Erecta, a Case Report

Abstract

Inferior shoulder dislocation (luxactio erecta) is a rare lesion affecting approximately 0.5% of dislocations of this joint. The vast majority of these cases occur unilaterally. In September 2004, a 43 year old man was brought to the emergency room of the University Hospital of Santa Maria (HUSM) complaining of bilateral shoulder pain and inability to lower the arms, as a result of a fall with the arms abducted, while carrying out work activities. After physical examination and radiological exams, it was found that the patient had a bilateral inferior shoulder dislocation. He was referred to the surgical ward and after intravenous sedation, both shoulders were reduced by closed reduction using the traction-countertraction maneuver. The patient was discharged the day after the reduction. Both arms were immobilized with a velpeau sling in total adduction and intrarotation, with instructions to maintain immobilization for three weeks. The patient was also advised to receive physiotherapy.

The 'Holy Grail' of shoulder dislocations: a systematic review on traumatic bilateral luxatio erecta; is it in reality a once-in-a-lifetime experience for an orthopaedic surgeon?

“…TBLE is highly associated with neurovascular injuries. In our systematic review, out of 42 cases, neurological deficits were found in 18 [ 10 , 19 , 21 , 26 , 29 – 31 , 35 , 36 , 38 , 39 , 41 , 47 – 49 , 52 , 53 , 58 ] (42,8%) including 1 case with bilateral complete brachial plexus tear [ 38 ] (accompanied with rotator cuff tear). On the other hand, vascular complications have been found in only one case.…”

Inferior Dislocation of Shoulder Complicated with Undisplaced Greater Tuberosity Fracture, Rupture of the Supraspinatus Tendon, and Brachial Plexus Injury in the Elderly: Case Report and Literature Review

“…The hand is often resting on, or next to, the head [10,11]. The average reported abduction of the humerus is 120°(80°-170°) on clinical assessment at presentation [3,8,11,16,20]. Closed reduction is typically performed either by manual manipulation of "traction- 3 Case Reports in Orthopedics countertraction" method, as described by Freundlich [12], or by a two-step technique, as described by Nho et al [13].…”

“…Bone fractures, such as great tuberosity, inferior glenoid fossa, acromion, scapular spine, coracoid process, and/or soft tissue injuries, such as avulsed shoulder capsules, rotator cuffs tears, or ruptures of the adjacent muscles (supraspinatus, infraspinatus, teres minor, sunscapularis) are likely with inferior shoulder dislocations [14,15]. Other complications are neurovascular compromise that may affect the brachial plexus (most commonly injury to the axillary nerve) and even an axillary vein causing thrombosis [4,14,16].…”