Bilateral spontaneous anterior shoulder dislocation: A missed orthopedic injury mistaken as proximal neuropathy

Abstract

A number of orthopedic injuries can occur during epileptic seizures. Anterior shoulder dislocation is one such orthopedic injury that is quite rare. The shoulder dislocation may injure the brachial plexus. Besides seizures, the nerves can also be damaged by anticonvulsive therapy. Muscle wasting following a seizure can misguide a clinician to investigate only neural or muscular pathologies. We report here an individual with epilepsy who was referred to us for electrodiagnostic evaluation of proximal muscle wasting related to a suspected proximal neuropathy. He was found to have a normal electrodiagnostic evaluation and later on discovered to have had bilateral shoulder dislocation on X-rays. This report advocates a thorough clinical appraisal, radiographs, and electrodiagnostic evaluation in a case with muscle wasting following a seizure.

Bilateral anterior shoulder dislocations: A review of two cases and the relevant literature

“…53 966). Muscular spasms can be caused by an epileptic seizure as seen in our cases, 3,17,22,24,26,30,39,51,106,107,109,113,114 an electrocution, 18,20,78,85 toxins (opiate, alcohol, chloroquine, and insecticide), 15,23,37,104,115 a hypoglycemia, 28,45,54 emotionally charged circumstances (nightmare and fear of death), 14,67,74 or from the vibrations of a digging machine 89 …”

“…Due to pathognomonic "symmetric square shoulder aspect," referring to bilateral flattened shoulders, and inability to internally rotate either shoulder, dislocations are rarely missed in trauma condition. However, nontraumatic and involuntary muscular contraction (IMC) conditions can lead to missed dislocations 9,14,18,19,21,22,31,39,41,44,64,67,83,85,95,96,100,105,106,115 . Acute injuries represented 85% of BSASD reported in the literature.…”

“…However, nontraumatic and involuntary muscular contraction (IMC) conditions can lead to missed dislocations. 9,14,18,19,21,22,31,39,41,44,64,67,83,85,95,96,100,105,106,115 Acute injuries represented 85% of BSASD reported in the literature. Twelve of the 20 chronic BSASD reported in the literature occurred in IMC conditions.…”

Neglected Bilateral Anterior Shoulder Dislocation Following Epileptic Seizure: A Case Report and Literature Review

“…In many cases patients have non-specific symptoms, such as pain and motion-range restriction. The absence of a traumatic event may lead to misdiagnosis, since the symptoms are attributed to muscle strains or tendinopathies [9,10]. Ballasteros et al in 2013 showed that in 15% of patients with nontraumatic bilateral anterior shoulder dislocation, diagnosis was established after a 3 week period following the causative event [3].…”

“…It is of note that 4 out of 12 cases (33.3%), described in the current literature Table 1) had a delayed firm diagnosis. In those cases the time between the epileptic event and diagnosis ranged from 3 weeks to 9 months [8][9][10]. History of antiepileptic therapy, clinical findings of painful restriction of shoulder movement followed by plain radiographs of the glunohumeral joint are of paramount importance for early recognition of such cases [3,8,11].…”