Three cases of bilateral antero-medial dislocations of the shoulder

Abstract

Introduction: Glenohumeral dislocation in its antero-internal variety is a very common lesion encountered in the context of emergencies (95% of cases). It can occur simultaneously on both shoulders. This clinical form is extremely rare in the literature since the forms described in epileptics are generally posterior pure. Thus, the aim of our study was to report the three cases of bilateral antero-internal dislocations and to review the literature. Materials and methods: This is a continuous prospective study from January 2014 to December 2015 and consisted of three patients all male. We used the Kocher technique for the reduction of dislocations with restraint by Mayo clinic after gluco- humeral insertion. Clinical assessment was based on physical examination and constant score. Rehabilitation had been carried out. Results: The surgery was simple with a resumption of their activities one month after surgery. The rehabilitation was undertaken as soon as the restraint was removed, ie on the 21st day. The constant score was considered excellent in these two patients. Discussion: In two of our patients, dislocation occurred in an epileptic setting. In effect only the violent, synchronous and sufficiently strong muscular contractions can explain this symptomatology. The peculiarity of this study is that it occurs on both shoulders in the antero-internal variety in two epileptics and a healthy subject. This clinical form is extremely rare in the literature since the forms described especially in epileptics were posterior pure. Hence a real contradiction. After orthopedic reduction by the Kocher technique, one of our patients (observation2) had an embedding of the two trochiters, and then in the other a screwing of the trochiter (observation1). A mayo clinic was set up after surgery. The third patient had bilateral dislocation of both shoulders in the antero-internal variety, following a traffic accident. Indeed it would have been struck then would have made a fall with reception on both hands and the buttock. This lesion has never been described in the literature, but other unusual traumatic mechanisms have been reported. Singh and Kumar [18] reported a case where both shoulders were dislocated by different mechanisms. The reduction was simple and we used the technique of Kocher and a contention by mayo clinic was carried out. It was revised to the 21st day concomitant with the removal of the mayo clinic and the beginning of rehabilitation. This during the constant score was judged to be bad and well below the average. Conclusion: We advocate, before a bilateral dislocation of the shoulder, in our context of exercise: - Reduction in emergency and under general anesthesia - rehabilitation should be undertaken as soon as the restraint is lifted This procedure will, of course, be discussed with our other orthopedic colleagues.