Bilateral Luxatio Erecta: A Case Report

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?

INTRODUCTION

Even though shoulder dislocation is thought to be the most common dislocation treated in the Emergency Department, inferior ones, known as Luxatio Erecta, comprise only 0.5% of them. Taking into consideration the rareness of unilateral Luxatio Erecta, bilateral cases should be even fewer. The purpose of this paper is to identify the reported number of cases of Traumatic Bilateral Luxatio Erecta in the literature over the last 100 years and to summarize the mechanism of injury, the initial management, and the complications of these patients.

MATERIALS AND METHODS

We performed a systematic review of the literature regarding Traumatic Bilateral Luxatio Erecta. All articles published until 31st of December 2022 in PubMed and Google Scholar databases were searched using the terms "luxatio erecta", 'inferior dislocation", and "bilateral".

RESULTS

Eighty-two articles were retrieved from PubMed and Google Scholar search. Forty-four of them were initially included in our review. Six additional articles meeting the inclusion criteria were found from cross-references.

CONCLUSION

The presence of this injury is extremely rare with only 51 cases in the literature. The incidence of concomitant injuries and complications seems to be extremely high and neurological deficits were detected on 42.8% of patients with Bilateral Luxatio Erecta. To our knowledge, this is the first systematic review of the literature regarding Traumatic Bilateral Luxatio Erecta that includes articles not only in English, a fact that provides more reliability on the estimation of the real number of cases of this rare injury compared to any other review on this subject to date.

Luxatio Erecta: A Case Report and Literature Review

Luxatio erecta (inferior shoulder dislocation) is a rare entity, infrequent, but with a good prognosis. There are two mechanisms for this injury to occur, by an indirect force, which is the most frequent, and by a direct force. Both involve hyperabduction of the arm. The clinical presentation is characteristic and unmistakable. Diagnosis is clinical, but imaging tests are useful to rule out associated injuries and complications. The treatment of choice is closed reduction and, in most cases with favorable results. We present the case of an 83-year-old woman who went to the emergency room with a diagnosis compatible with Luxatio erecta of the glenohumeral joint. Subsequently, a closed reduction was performed with good results. The patient is currently undergoing physical therapy and rehabilitation.

A rare case of bilateral antero-internal shoulder dislocation in a judo player: a case study and review of the literature

Pure anterior bilateral shoulder dislocations are rare clinical features, especially in traumatic forms. They are most often posterior, occurring during an epileptic seizure. Few cases are described in the literature, and the mechanism varies from case to case. We report a specific case of pure bilateral anterior shoulder dislocation in a 29-year-old judo player following an accident during his training and discuss the circumstances, mechanism, treatment, and prognosis.

Bilateral Luxatio Erecta Humeri

CASE PRESENTATION

We describe a middle-aged male presenting to the emergency department with bilateral shoulder pain, holding both arms in abduction after trauma. Radiographs demonstrated a bilateral inferior dislocation of the glenohumeral joints consistent with luxatio erecta humeri.

DISCUSSION

We review the clinical presentation of luxatio erecta and its complications. We also describe the characteristic presentation on radiographs. Our case illustrates the hallmark findings of luxatio erecta of an abducted humeral shaft parallel to the scapular spine.

Bilateral Erecta Luxation: A Case Report and Literature Review

CASE

A 69-year-old man fell from a height, resulting in direct axial loading while both shoulders were fully abducted. He was referred to the surgical ward, and both shoulders were reduced by closed reduction using the traction-countertraction maneuver. After little improvement of complaints of pain in the right shoulder over 45 days, magnetic resonance demonstrated traumatic rupture of the supraspinatus.

CONCLUSION

Inferior dislocation (luxation erecta) is an uncommon event, with bilateral dislocation being even rarer. Treatment should be initiated urgently via closed reduction or, if this is not possible, through open reduction. The long-term prognosis is favorable after appropriate treatment.

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

Inferior dislocation of the shoulder, also called luxatio erecta, is a rare form of the otherwise common shoulder dislocation. It appears in less than 0.5% of all shoulder dislocations. An awareness of associated potential axillary artery injury, brachial plexus complications, and rotator cuff tears is important in this rare entity and should be excluded with a high index of suspicion. In our case report, we have an 83-year-old female who inferiorly dislocated her dominant shoulder with brachial plexus injury and musculotendinous injury, which was caused by an accidental fall. The dislocation was manually reduced at the emergency department. After 18 months of conservative treatment with physical therapy, the range of motion and muscle strength of the shoulder recovered to a satisfactory mobile level according to the patient's demands.

Current Approach to the Diagnosis and Management of Shoulder Dislocation in Children

Shoulder dislocations are a common presentation to the emergency department. Although many cases may be diagnosed by history and clinical examination alone, imaging may help diagnose more challenging cases. Three-view radiographs are important for identifying subtle posterior dislocations, and ultrasonography has been gaining evidence as an alternate diagnostic modality. Intra-articular lidocaine and nerve blocks may improve pain control and reduce the need for procedural sedation. Multiple, evidence-based reduction techniques are described including tips for improving success. Immobilization strategies and follow-up are also discussed.

[Pure bilateral anterior dislocations of the shoulder of special mechanism: report of two cases]

Les luxations bilatérales antérieures pures des épaules sont des entités cliniques rares. Une trentaine de cas sont décrits dans la littérature. Le mécanisme varie d'un cas à l'autre, les épaules en abduction et en rétro-pulsion, coudes en extention et en supination a été décrite une seule fois dans la littérature. A ce propos, les auteurs rapportent ce même mécanisme particulier de luxation antérieure bilatérale pure des épaules chez deux jeunes patients, et discutent des circonstances, mécanisme de survenue, du traitement et du pronostique.