文章基本信息

标题：Bilateral Shoulder Dislocation after Ski Injury
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作者：Rajagopal, Alaina ; Knight, Brian ; Orr, Lance 等
期刊名称：Journal of Education and Teaching in Emergency Medicine
印刷版ISSN：2474-1949
出版年度：2019
卷号：4
期号：1
页码：1-2
DOI：10.21980/J86929
出版社：University of California Press
摘要：History of present illness: The patient was a 60-year-old male who had been skiing when he abruptly fell with arms overhead (superman position). The patient immediately experienced bilateral shoulder pain and wasrushed to the clinic associated with the ski resort. On physical exam, he had bilateralstep-off deformities and both shoulders were abducted approximately 15 degrees with elbows flexed at 90 degrees. He promptly received X-rays which demonstrated bilateral anterior shoulder dislocation and left humeral head fracture. Significant findings: An anteroposterior chest X-ray demonstrates bilateral shoulder dislocations. Both the right and left humeral heads (blue lines) are displaced medially, anteriorly, and inferiorly from their normal positions in the glenoid fossae (red lines), thus signifying bilateral anterior dislocations. There is also a fracture of the left humeral head at the greater tubercle (green arrow). Discussion: While anterior shoulder dislocations are the most common major joint dislocation seen in emergency departments, bilateral anterior shoulder dislocation is exceedingly rare.1,2 There are few other cases of bilateral shoulder dislocation reported in the literature. Most are posterior dislocations related to Return: Calibri Size 10 7 seizure, electrocution, or trauma, with fewer than 50 casessince 1966.1,3,4,5 The first report was in 1902.1 The mechanism is fairly specific for anterior dislocation with multiple publications reporting the patient falling onto bilateral outstretched hands. Another less common mechanism is trauma sustained with arms in the “pushup position.” 2 Initial presentation of bilateral anterior shoulder dislocation is usually obvious on physical exam. A patient’s shoulders may be externally rotated and abducted. Patients may also exhibit bilateral squaring of the shoulders with flattened lateral deltoid known as the epaulet sign (named for the French term for shoulder ornaments of military uniforms).2,6 Treatment is the same for unilateral dislocation, and requires immediate reduction with subsequent evaluation for any neurovascular compromise. Though 20% of bilateral dislocation cases present with neurologic symptoms, 75% of these resolve after reduction.2 After reduction the patient’s affected arms should be immobilized via slings. The most commonly chosen position is to keep the shoulders adducted and internally rotated. Younger patients can remain in the slings for three weeks; however, patients over the age of 30 should begin early mobilization after one week to prevent adhesive capsulitis. 7 The patient should follow up for orthopedic evaluation and physical therapy for range of motion exercises.8 About 23% of patients with this rare bilateral deformity will require some form of follow-up surgery.2 In this case, the left-sided reduction was completed easily by forward flexion of the arm with acromion pressure and medial rotation of the scapula without analgesia. The right shoulder required administration of analgesia and two reduction attempts with successful reduction using external rotation and abduction. Repeat X-rays were obtained showing adequate reduction. The patient was neurovascularly intact before and after reduction. The patient was immobilized in slings and orthopedic follow up with physical therapy was prescribed.