Epidemiology and specific features of shoulder injuries in patients affected by epileptic seizures

Abstract

Purpose Epileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications. Methods All patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions’ characteristics and trauma dynamics were analysed, as wells as—when carried out—the type of surgical intervention and any postoperative complications. Results The average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%). Conclusions Uncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success. Level of evidence Cohort study, level III.

Bilateral Locked Posterior Fracture-Dislocation of the Shoulder After Epileptic Seizures Secondary to Cavernous Hemangioma: A Case Report and Literature Review

“…This frequently results in bilateral lesions, anterior and posterior dislocations, or fracture-dislocations, as in our case. Shoulder injury treatment in epilepsy patients is associated with higher complication rates: recurrent instability was identified in almost two-thirds of patients treated operatively [ 13 ]. Rouleau et al reported that humeral head impression fractures – also known as reverse Hill-Sachs lesions – were the most frequently observed fracture type (29%), followed by humeral neck fractures (18.5%) and fractures of the lesser (14.3%) and greater (7.8%) tuberosities, with other fractures (humeral diaphysis, scapula, and clavicle) present in 6% of cases [ 14 ].…”

Bilateral Dorsal Fracture-Dislocation of the Proximal Humerus

“…V 16 % prípadov sa vyskytlo obojstranné poranenie počas jedného záchvatu. V 40 % vznikla luxačná zlomenina (5). Asi 5 % prvých luxácií ramenného kĺbu je spôsobených záchvatom rôzneho druhu (asi v 40 % epileptickým).…”